Job Details

Job Description:

Job Tittle: Customer Service Representative/ Claim Representative
Job Location: 100% Remote

Primary Responsibilities:

• Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
• Providing excellent customer service, including the ability to handle escalated callers
• Determining authorization or notification requirements
• Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
• Providing administrative approvals (depends on line of business)
• Handling expedited authorizations, authorization updates and status checks
• Confirming member eligibility
• Outreaches to providers and/or Patient to complete authorization requests and prescriptions
• Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
• Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
• Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
• Performs all other related duties as assigned.
• You ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required experience:

• Medical Terminology
• ICD 9/ICD 10 and CPT knowledge
• Claim Experience
• Call center experience
• Highschool Diploma minimum is required and will be verified
• 1.5 to 2 years of claims experience

Qualifications:

• High School Diploma / GED (or higher) (This will be verified through $Diverse Lynx$)
• 2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
• Ability to work one of the varying shifts to support our 24hr 7 days a week operation
• Proficiency with Microsoft Office Word (create and maintain documents), Excel (create and maintain spreadsheets) and Outlook (email and calendaring) Medical Terminology
• ICD-9/ICD-10 and CPT Knowledge
• Required to have a dedicated work area established that is HIPPA compliant.
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive approved high-speed internet connection or leverage an existing high-speed internet service