Customer Service Representative

PHYSICIANS DATA TRUST • Vista, CA

13d • $18 - $25

About The Position

To provide high-level customer service to PDTs’ clients with accuracy.

Requirements

• Ability to speak, read, write, and understand English.
• General educational skills, as is generally obtained by completing high school or a GED.
• Knowledge of the health or managed care industry.
• Excellent communication skills with a focus on superior telephone etiquette.
• 1-2 years of customer service experience required.
• Ability to organize and maintain multiple sets of information and data.
• Consistently produces accurate and timely work as it relates to departmental goals.
• Demonstrates high reliability through consistent punctuality and attendance.
• Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through.
• Uses sound judgment regarding time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required.
• Demonstrates excellent interpersonal skills as discerned through observation and team project successes.
• Accurately interprets and applies departmental policies and procedures using sound judgment.
• Communicates professionally and respectfully with peers, superiors, subordinates, and clients.
• Provides constructive feedback on assigned work projects.
• Demonstrates overall professionalism in attitude, demeanor, and personal appearance.

Nice To Haves

• Knowledge of the health or managed care industry is generally obtained through 1-2 years of work experience.

Responsibilities

• Answer calls from members, providers, and health plans regarding specific claim issues.
• Route and redirect calls as necessary.
• Return calls from the UM voicemail box within 24 hours.
• Perform timely follow-up on calls requiring research and call back within 24 hours.
• Accurately interpret DOFRs – Division of Financial Responsibility documents to determine where specific health care services are rendered.
• Verify eligibility & benefits for each submitted physician referral by contacting health plans for pertinent information.
• Work with contracting personnel to ensure the utilization of appropriate providers.
• Provide requested referral and network information to providers/staff promptly within 24 hours.
• Use MedMC to log incoming calls and their resolution.
• Complete other projects as assigned by the supervisor.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED