- Answers telephones and responds to basic customer questions and/or forwards to appropriate personnel and provides consultancy utilizing knowledge and expertise on insurance and healthcare.
- Develops and implements general insurance and health care policies in accordance with state and federal laws and provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.
- Responds to provider appeals and meets with providers to resolve problems/issues. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.
- Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls, processes requests and updates account history with results of inquiry to include proper documentation.
- Interfaces with team members, management, and customers in reference to customer service issues. Review and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.
- 2 or more years of customer service experience in any industry
- Knowledge of basic help desk software, computer software and Microsoft Office applications
- Strong problem-solving skills to bring inquiries to effective resolution
- Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
- Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries
- Hours of Operation: 8:00 AM ET – 5:00 00 PM ET candidate must be able to work any assigned 8 hour shift between these hours.
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