Employer Service Rep

The Health Plan of West Virginia Inc • Wheeling, WV

1d • Onsite

About The Position

The Employer Service Representative (ESR) serves within the Customer Service Department handling complex and escalated phone and written inquiries from internal and external customers. The ESR builds and maintains rapport with members, providers, account executives, clients, brokers, employees and other entities. They research and resolve escalated issues with claims, network relations, benefits, eligibility, member experience, etc.

Requirements

• High School graduate or equivalent.
• Proficient use of a computer.
• Written correspondence etiquette.
• Self-starter and works independently.
• Detail oriented with excellent problem solving skills.
• Ability to prioritize and meet deadlines.
• Maintains confidentiality.
• Superb oral and written communication skills.
• Proficient in Microsoft Office products (Word, Excel, Power Point and Office).
• Easily adapts to changes in work requirements.
• Can work easily with others and collaborate with team members.

Nice To Haves

• Bachelor’s degree from an accredited college or university.
• Previous experience in working with health insurance.
• Medical Terminology.
• Knowledge of CPT and ICD-9/ICD-10 coding.
• Knowledge of medical and hospital claims.

Responsibilities

• Answer all calls and written correspondence in a timely, professional and friendly manner.
• Communicates with clients, members and providers as necessary to obtain information to resolve issues.
• Communicate with self-funded networks to research claim processing errors, process network settlements and process pre-service agreements.
• Works with claims team and core customer service team to manually enter claims in network portals and request written correspondence to process claims.
• Records and tracks all information clearly and accurately.
• Understands benefits, eligibility, copay, coinsurance and deductibles in order to relay this information clearly and accurately.
• Understands claim detail, identifies claims issues and reports issues to the Manager when necessary.
• Keep all member protected health information (PHI) confidential.

What This Job Offers

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