Medical Claims Customer Service Representative (Remote)

TEKsystems • Sacramento, CA

2d • $20 - $22 • Remote

About The Position

Provide call center callers with timely, accurate, and customer-focused claim information, solicit information needed to perfect the claim, consistently deliver a superior level of customer service, document the claim system, work with the Supplemental Health and Limited Medical Benefit products, and perform well in a call center team environment.

Requirements

• Minimum of 2 years of experience in a call center environment, within the health insurance/medical claims industry.
• Strong understanding of health insurance claims and benefits. Particularly Scheduled Accident, Critical Illness, and Hospital Indemnity plans preferred.
• Knowledge of HFCA 1500 & UB04 forms
• Ability to recognize CPT & revenue cycle codes.
• Must have a high school diploma or GED.
• Proficiency in MS Office applications

Nice To Haves

• Particularly Scheduled Accident, Critical Illness, and Hospital Indemnity plans preferred.

Responsibilities

• Customer Service Calls: Provide customers with timely, accurate, and customer-focused benefit and claim information.
• Solicit and enter the information needed to enter and process claims accurately and in a timely manner.
• Record summaries of information exchanged in our claim system with a high level of accuracy and detail easily understood by the user.
• Issue timely and accurate claim acknowledgement correspondence.
• Process incoming documents with high coding integrity and distribute immediately.
• Remain fully compliant with operational standards.
• Meet or exceed call center operational metrics.
• Claims Registration: Enter incoming claims information with high degree of accuracy, meeting or exceeding established metrics.
• Comprehensively review and evaluate appeal and complaint requests to identify and classify member and provider appeals.
• Determine eligibility, benefits, and prior activity related to the claims, payment, or service in question.
• Research appeal files for completeness and accuracy and investigate deficiencies.

Benefits

• Medical, Dental & Vision Benefits offered.
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

What This Job Offers

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