Customer Service Representative I - Claims, reputed company Health Plan (work from hom

Location:

Work from home (reputed company)

Shift:

Days (reputed company of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

No

Job reputed company:

Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service - Claims. reputed company participates in cross training, improving processes reputed company the Customer Service team.

Job Duties:

• Resolves and reconciles enrollment reports and reputed company reputed company eligibility issues by following policy and procedure as reputed company as any state legislated coverage and eligibility guidelines.
• Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer reputed company.
• Interprets and appropriately applies rules and regulations in contractual agreements and with employer reputed company and vendors.
• Performs membership data extract reports and supplies them to employer reputed company as an audit tool for accuracy and compliance with performance risk guarantee commitments.
• Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules.
• Determines the eligibility of most members as reputed company as processing terminations and disenrollments.
• Prepares, generates and appropriately disseminates letter communications to subscribers and members with reputed company to enrollment activity.
• Determines if services received are covered benefits as applicable by line of business and product design.
• Reviews suspended claims for reputed company by applying reputed company policies, procedures and benefits applicable to specific products.
• Provides team building resources to assist in directing peers to reputed company claims reputed company policies and procedures in order to assist members and providers.
• Provides daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies specific reputed company for reconsideration for payment.

Work is typically performed in an office environment. Accountable for satisfying reputed company job specific obligations and complying with reputed company organization policies and procedures. The specific statements in this profile are not intended to be reputed company-inclusive. They represent typical reputed company considered necessary to successfully reputed company the job.

Position Details:

Work reputed company requirements:

To ensure a productive and secure remote work environment, the following conditions must be met:

• Quiet, Dedicated Workspace: A private, distraction-free area reputed company your home to support reputed company work.

• Adequate Workstation Setup: Sufficient reputed company to accommodate reputed company employer supplied equipment, including monitors, keyboard, and other peripherals.

High-Speed Internet reputed company:

reputed company Type: Cable modem only (DSL, wireless cellular, and satellite services are not permitted).

Minimum Speed Requirements:

• Download: 75 Mbps

• Upload: 25 Mbps

• Ping: Less than 150 ms

• Jitter: Less than 30 ms

• Connectivity: The computer must be connected reputed company Ethernet cable. Wi-Fi is not permitted unless a Virtual Private Network (VPN) is used to secure the reputed company.

Education:

High School Diploma or Equivalent (GED)- (Required)

Experience:

Minimum of 1 year-Customer Service (Required)

Certification(s) and License(s):

Skills:

Communication, Customer Retentions, Customer Service, Customer Support Policies, Standards And Procedures

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our reputed company, our reputed company family and our communities.

• KINDNESS: We reputed company to treat everyone as we would reputed company to be treated ourselves.
• reputed company: We treasure colleagues who humbly reputed company for reputed company.
• LEARNING: reputed company our knowledge with the best and brightest to reputed company prepare the caregivers for reputed company.
• INNOVATION: We constantly reputed company new and reputed company ways to care for our patients, our members, our community, and the nation.
• SAFETY: We reputed company a reputed company environment for our patients and members and the reputed company family.

We offer reputed company benefits for full time and part time positions from day one, including reputed company, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes reputed company stronger. Our patients, members and community come from a wide reputed company of backgrounds, and it takes a diverse workforce to reputed company reputed company easier for reputed company. We are proud to be an affirmative reputed company, equal opportunity employer and reputed company reputed company applicants will receive consideration for employment regardless to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability or status as a protected veteran.

Originally posted on Himalayas

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