Medical Claims Customer Service Representative (Remote)

TEKsystems•Boulder City, NV

1d•$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

Experience: Minimum of 2 years of experience in a call center environment, within the health insurance/medical claims industry.
Knowledge: 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

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.