Customer Service Representative

Job description

As a Customer Service Representative, you interact with customers to provide information in response to inquiries about claims. This is a front line position in our medical department and is crucial in setting the tone for fulfilling our promise of providing exceptional white-glove service to our claimants and callers. You will use your independent judgment and communication skills to obtain information and relay information to claimants and providers. Responsibilities include: - Answering incoming telephone calls. Required to login into phone queues (as assigned) daily. - Providing eligibility and claim information to medical providers and members. - Reviewing and interpreting plan certificates to determine covered benefits and limitations/exclusions. - Investigating claim payment issues. - Research PPO websites/database as required to determine if claims are received and processed by the PPO network. - Document telephone call reason and details in claim system. - Monitoring and answering voice mail. - Review inventory tool for status requests from providers/members and respond professionally. - Initiate check inquiries (check tracers) from providers and members to determine if cl...