Job Description
About the Role:
We're looking for a compassionate and knowledgeable Healthcare Customer Service Representative to join our team! This role is key in assisting members with policy management, benefit inquiries, and claims processing. You'll bring your expertise in healthcare terminology, including ICD-9 and ICD-10 coding, to provide exceptional service and ensure members have a smooth experience.
As a Healthcare Customer Service Rep II, you'll be a valuable team member, answering member calls and resolving concerns related to healthcare policies, benefits, and claims. You'll help us ensure every member receives the best possible service, guiding them through their questions with accuracy and care.
Job Type:
Full-time - 100% Remote Position
Schedule:
Monday - Saturday, 9:00 AM to 11:00 PM EST / 8:00 AM to 10:00 PM CT (Shifting Schedule)
Responsibilities:
Policy Management:
Billing: Process member payments, address billing inquiries, and resolve any discrepancies.
Member Information Updates: Accurately update member details, including contact info, beneficiaries, and employment data.
Policy Terminations & Reinstatements: Manage policy termination requests and assist with reinstatements.
ID Card Ordering: Efficiently process ID card requests and ensure timely delivery.
Benefits:
Coverage Information: Provide members with clear and accurate details about their coverage, eligibility, and plan benefits.
Prior Authorization & Referrals: Help members navigate the prior authorization and referral processes.
Healthcare Provider Contact: Research and provide up-to-date contact information for healthcare providers.
Claims:
Claims Status Updates: Provide timely updates on claims status and explain the processing stages.
Claims Inquiries: Answer questions related to claim processing and offer guidance on submitting appeals.
Claims Reconsideration Requests: Assist with reconsideration requests for denied claims, gather necessary documents, and support the appeal process.
General Inquiries:
Website Troubleshooting: Help members resolve issues with the member website and guide them through troubleshooting steps.
General Questions: Provide clear and accurate answers to general health insurance inquiries.
Additional Responsibilities:
Maintain Confidentiality: Safeguard sensitive member information in compliance with confidentiality policies.
Escalate Complex Issues: Forward complex or unresolved issues to supervisors for further assistance.
Continuous Learning: Stay updated on the latest health insurance policies, regulations, and processes.
Team Collaboration: Work effectively with your team to achieve goals and maintain a positive work environment.
Preferred Experience:
Strong computer skills, including data entry, screen navigation, and keyboarding.
Excellent customer service skills and ability to handle multiple tasks with attention to detail.
Excellent oral and written communication skills.
Solid knowledge of healthcare terminology, eligibility, benefits, medical claims, and ICD-9/ICD-10 coding.
Self-motivated, organized, and able to manage time effectively.
Ability to work both independently and as part of a team.
Requirements:
High School Diploma or GED.
2-3 years of experience in claims examination, health insurance, customer service, call center, or medical office.
Must pass a criminal background check.
Work From Home Requirements:
High-speed internet (25MBPS download, 5MBPS upload). You will need to provide a speed test.
Ability to hardwire directly to your modem.
Quiet, dedicated workspace.
What We Offer:
Paid training period.
Health benefits, including medical, dental, vision, life, and HSA options.
401K and paid time off (PTO).
Necessary equipment provided.
Employment Type: Full-Time
Salary: $ 17.00 19.00 Per Hour
Job Tags
Hourly pay, Full time, Remote job, Shift work, Saturday,