Customer Service Representative - Coastal TPA
Aspire Health Plan
Associate Degree Required
Customer Service Representative
· Excellent Pay and Generous Benefits
· Team Oriented Culture
· Excellent work environment!
The Customer Service Representative is responsible for answering telephone inquiries and responding to correspondence from employer clients, members and providers regarding eligibility, claims status and benefit determinations.
- Intake all customer (provider, member and health plan) calls as they relate to inquiries and grievances.
- Explain health insurance benefits, policies and procedures to members and providers, i.e., claims submission, appeal process, medical review, documenting all communication.
- Investigate timely filing of provider claims.
- Serve as a point of contact and liaison for customers.
- Successfully implement dispute resolution.
- Provide proactive and event-related education to customers.
- Facilitate customer care as appropriate.
- Assure accurate and timely response to all customer inquiries.
- Log calls and document action plans.
- Successfully bring all issues to closure within appropriate timeframe.
- Proactively identify areas of improvement and provide feedback.
- Perform member and provider satisfaction surveys as appropriate.
- Provide support and coverage to interdepartmental staff as needed.
- Coordinate customer grievances with appropriate department.
- Develop strong partner relationship with customers.
- Perform other activities and functions as defined by the Claims Manager.
Experience/Skill Set required:
· Minimum two years' experience in customer service/call center within the managed care, insurance, healthcare, or related call center environment
· Strong comprehension skills
· Ability to communicate effectively, including written and verbal communication skills
· Attention to details in obtaining complete and accurate information
· Problem resolution skills
· Strong interpersonal and negotiation skills
· Ability to key data accurately and rapidly
· Basic knowledge of insurance terminology and medical coding, e.g. ICD and CPT
· Ability to operate computer equipment and software programs necessary to fulfill position responsibilities
· Working knowledge of Microsoft office products including Outlook, Word, and Excel
· Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff.
· Excellent phone manner and ability to handle multiple phone lines.
· Must be able to meet established deadlines
· Minimum A.A. degree or equivalent practical experience in related or similar positions.
Equal Opportunity Employer
Job Reference #: 108186