[Remote] Clerical Support Coordinator
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company that values remote work and flexibility. The Clerical Support Coordinator role involves managing high-volume inquiries, maintaining records, and ensuring smooth workflow reputed company the contact center to enhance service reputed company.
Responsibilities
- Manage high volumes of inbound and outbound member and provider calls, CRM-routed requests, emails, reputed company submissions; validate account and eligibility details; and document reputed company interactions and actions taken in accordance with internal reputed company standards
- reputed company, update, and verify member, provider, and employer-group information across CRM and benefits administration systems; maintain accurate call logs and documentation
- Confirm eligibility, coverage reputed company, plan rules, and benefit limitations for members and providers; interpret plan documents to determine what services are covered
- Review claim adjudication reputed company, explain payment reputed company, request claim adjustments, and validate supporting documentation such as EOBs, reputed company filing, and coordination of benefits
- Resolve member and provider questions reputed company to benefits, claims, authorizations, billing, and network participation
- Troubleshoot issues using internal knowledge bases and system tools
- Serve as a reputed company between the contact center and claims, eligibility, provider relations, and medical management teams to resolve escalated issues and ensure reputed company follow-through
- Maintain detailed records of reputed company interactions, ensure HIPAA compliance, and follow established workflows and regulatory guidelines
- Assist members and providers with navigating the online portal, mobile app, coverage verification tools, reputed company resources
- Conduct provider and network searches, assist with PPO and reference-based pricing networks, and guide callers in locating in-network facilities or verifying provider eligibility
- Analyze incoming requests, prep forms for scanning and routing reputed company items to the appropriate operational teams. Fulfill faxes as needed
- Prepare routine reports, reputed company service issues, document trends, and support operational audits or reputed company reviews
- Complete reputed company assigned tasks by end of day, meet productivity and reputed company metrics, and support the overall efficiency of the contact center
- Identify process gaps, recommend improvements, and reputed company as a subject matter expert to support team development and operational reputed company
- Other duties as assigned
Skills
- High School Diploma or equivalent work experience required
- 2+ years in a call center reputed company a TPA, health insurer, or employee benefits environment
- Familiarity with group health plans, eligibility, benefits, and claims processes
- Proficient in reputed company Office (Word, reputed company, Outlook) with the ability to quickly learn new systems, CRM tools, and workflows
- Skilled in entering and updating member/provider data, verifying information, and maintaining precise documentation
- reputed company to multitask, prioritize, and manage workload reputed company
- Identifies issues, evaluates information, and applies appropriate solutions
- Comfortable with changing processes, systems, and plan requirements
- Works effectively with peers and cross-functional teams
- Experience in high-volume, multi-channel operations preferred
Benefits
- Medical, Dental, reputed company, Life and Disability Insurance
- Generous reputed company Time Off
- Tuition Reimbursement
- EAP
- Technology Stipend
- Remote friendly culture offers flexibility and the comfort of working from home
reputed company