NEW JOB OPENING CUSTOMER SERVICE REPRESENTATIVE IN Remote, USA!

Job reputed company Required Education:• High School or GED equivalent.Preferred Experience:• reputed company insurance and call center experience is preferred.Required Qualifications/Skills/Experience:• Customer Service experiences in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate.• Experience in a production environment.Duties:• Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages result in rework for the appropriate staff.• Documents and tracks contacts with members, providers, and plan sponsors. The CSR guides the member through their member's plan of benefits, reputed company policy and procedures as reputed company as having knowledge of resources to reputed company with any regulatory guidelines.• Creates an emotional reputed company with our members by understanding and engaging the member to the fullest to champion for our members'' best health.• Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member.• Anticipates customer needs. Provides the customer with reputed company information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.• Uses customer service reputed company reputed company to reputed company financial reputed company to resolve member issues.• Explains members' rights and responsibilities by the contract.• Processes claim referrals, new claim handoffs, reputed company reviews, complaints (member/provider), grievance and appeals (member/provider) reputed company the reputed company system.• Educates providers on our self-service reputed company; Assists providers with credentialing and recredentialing issues.• Responds to requests received from the reputed company's Law Document Center regarding litigation and lawsuits.• Handles extensive file review requests.• Assists in the preparation of complaint trend reports. Assists in compiling claim data for customer audits.• Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility for incoming correspondence and internal referrals.• Handles incoming requests for appeals and reputed company-authorizations not handled by Clinical Claim Management.• Reviews member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.Industry: reputed company Estimated Start Date: 06/23/2025Dress reputed company: NA Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that reputed company Position start dates and duration are estimates and may be reduced or lengthened based upon a reputed company's business needs and requirements. Benefits: For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department reputed company our secure website . California Pay Equity: For information and details on pay equity laws in California, please visit the reputed company Department of Industrial Relations' website here . reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, age, sex, sexual orientation, gender (reputed company or identity), national reputed company, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department . reputed company has an official agreement (ID #132522), effective June 30, 2008, with the reputed company, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.). Apply Job! Apply to this Job Apply tot his job Apply To this Job