About The Position
Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service. Actively participates in cross training, improving processes within the Customer Service team.
Requirements
- High School Diploma or Equivalent (GED)
- Minimum of 1 year Customer Service experience
- Communication skills
- Customer Retentions skills
- Customer Service skills
Responsibilities
- Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
- Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
- Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors.
- Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
- Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules.
- Determines the eligibility of most members as well as processing terminations and disenrollments.
- Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity.
- Determines if services received are covered benefits as applicable by line of business and product design.
- Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
- Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
- Provides daily support and advice to member and provider services staff regarding claims issues.
- Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.
- Work is typically performed in an office environment.
- Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.
Benefits
- Healthcare benefits for full time and part time positions from day one
- Vision insurance
- Dental insurance
- Benefits for domestic partners
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
