Job Description
Provider Claims Customer Service
Location: Remote – NJ; FL; IL; KS; KY; LA; MD; MI; TX US
Category: Call Center|Claim|Customer Service
Job Type: Fully remote – Full-Time
Salary: 17.00 – 27.90 /hour
Job Description:
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
- Triages resulting rework to appropriate staff. Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research team. Extensive claims research on multiple platforms to assist providers with payment questions.
- Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
- Uses customer service threshold framework to make financial decisions to resolve member issues.
- Explains member’s rights and responsibilities in accordance with contract.
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system .
- Educates & assists providers on our self-service options.
- Assists providers with credentialing and re-credentialing and contracting questions and issues.
- Assists in compiling claim data for customer audits.
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
Work Hours: 8am to 7pm EST or 8am to 7pm Central
Pay Range
The typical pay range for this role is:
- Minimum: 17.00
- Maximum: 27.90
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
- Familiarity with Microsoft Office products
- High speed internet access (25 mbps)
- Is your router located in a place where you could set up and work with a direct connection (NOT WI-FI) (ethernet cord directly from computer to router). We provide a 6 foot long ethernet cord, if the distance is further, you will be required to provide your own ethernet cable
Preferred Qualifications
- Claims and coding knowledge
Education
- High School diploma or GED equivalent.