Claims Customer Service Representative

INNOVATIVE INTEGRATED HEALTH•Fresno, CA

5d•$19 - $23•Onsite

About The Position

The Claims Customer Service Representative (CCSR) serves as a critical liaison between Innovative Integrated Health, Inc. (Company) and external healthcare providers (Providers). The CCSR handles incoming inquiries from Providers who submit claims to the Company. The CCSR is expected to act with a high level of professionalism, confidentiality, and efficiency. The role requires excellent judgment, strong communication skills, and the ability to manage multiple priorities in a fast-paced environment. The CSSR is expected to demonstrate a high level of accuracy and attention to detail while upholding regulatory and privacy standards as mandated by the Health Insurance Portability and Accountability Act (HIPAA).

Requirements

Proficient in Microsoft Office (Excel, Outlook, Word)
Familiarity with medical billing terminology (ICD-10, CPT, HCPCS) and Explanation of Payments (EOPs).
Strong oral and written communication skills.
Proven ability to multi-task and remain detail-oriented under pressure.
Strong interpersonal and problem-solving skills; collaborative mindset.
Ability to learn and apply regulatory requirements quickly.
Ability to access all areas of the center throughout the workday.
Ability to lift a minimum of 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another employee when attempting to lift or transfer objects over 50 pounds.
Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
Ability to communicate verbally with an excellent comprehension of the English language.
Minimum of two (2) years work experience required.
At a minimum a High School Diploma or GED is required.
Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact.

Nice To Haves

knowledge of claims processing software, preferred.
Minimum of one (1) year of experience working in a healthcare call center, preferred
Experience working remotely, preferred.

Responsibilities

Respond to Provider inquiries regarding medical and dental claims via phone and email.
Research and resolve issues related to claims status, denials, and payment discrepancies.
Maintain up-to-date knowledge of benefit plans, claim adjudication guidelines, coding requirements, and HIPAA regulations.
Accurately document all interactions and claim actions in the Company system by compliance standards.
Maintain accurate records of interactions and claim resolutions.
Communicate complex benefit details in a clear and concise manner to Providers.
Collaborate with internal departments to facilitate resolution of claims-related issues.
Recommend process improvements to enhance service delivery and improve Provider experience.
Provide empathetic and efficient service to when working with Providers.
Ensure all duties are completed with a focus on quality, compliance, and Provider satisfaction.
Maintain punctuality, professionalism, and adherence to company policies and attendance requirements.
Attend and participate in audits, staff meetings, in-services, and other projects as assigned.
Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
Flexibility to adjust schedule as needed to meet operational demands.