Insurance Customer Service Specialist

Job description

Here’s what you will be doing: - Resolves customer service issues, expedites the adjustments, and follow ups to ensure the resolution; adjudicates required claim adjustments identified through communication with members, employees, and clients - Updates and maintains information and knowledge regarding plans and benefits administered by the Insurance Department; educates members and external customers on policies and procedures related to members’ health care program - Interprets member eligibility and coverage through knowledge benefit plans, Purchased Referred Care programs, claims and departmental procedures needed to assist Tribal members, employees, and other clients; initiates check tracers and investigate claim payment irregularities - Collaborates with the FCPHWC, ICW, Child Support, Economic Support, Elderly, and other FCP Departments to assist in providing Tribal members information needed to ease access to care; assists in the development and communication of resolutions, procedures, and policies to internal staff, as requested - Identifies trends/issues that emerge in calls/correspondence, and informs Supervisor or Director - Communicates the required information effect...