Sr. Customer Service Specialist

Claritev•New York, NY

6h•$24

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! JOB SUMMARY: This position is responsible for the handling, research, and communication regarding complex and escalated claims inquiries stemming from patients, clients, providers, and internal customers', including both intake and resolution. In addition, this position is also responsible for coaching and mentoring.

Requirements

Minimum completion of high school (i.e., diploma or GED)
Minimum 3 years experience in the healthcare industry or customer service, preferably with out-of-network claims.
Required licensures, professional certifications, and/or Board certifications as applicable.
Bilingual English/Spanish may be required of some positions.
Knowledge of health care claims and appeal procedures .
Knowledge of insurance company and medical service provider vocabulary desirable
Communication (written, verbal and listening) problem solving, interpersonal and decision-making skills.
Ability to create and compose business correspondence
Ability to multitask while setting priorities
Ability to analyze data and arrive at a logical conclusion
Ability to identify issues and determine appropriate course of action for resolution
Ability to elicit trust and credibility with all levels of the organization
Ability to work with accuracy in a fast-paced environment
Ability to adjust/alter workflow to meet deadlines
Ability to work independently as well as part of a team
Ability to handle confidential information.
Ability to handle high pressure situations and variance in workload volume
Ability to use software, hardware and peripherals related to job responsibilities including MS Office
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Responsibilities

Investigate, analyze, research, and resolve complex and escalated claim inquiries from patients, clients, providers, and internal customers' as a result of issues related to discounts, payments and balance billing. This includes handling legal inquiries or department of insurance complaints.
Provide resolution and closure to the applicable recipients. Create and execute business correspondence to clients or providers using multiple media formats such as but not limited to emails, form letters, and issues specific letters. This includes initiating resolution and follow up calls to clients and providers.
Adhere to client turn around requirements as it relates to response time and required actions.
Ensure investigative notes related to any contact with providers and clients are documented and accessible throughout the applicable systems.
Ensure the maintenance of and compliance with department standards for production, accuracy, and turnaround time.
Perform system claim adjustments based on outcomes and communicate with client regarding confirmation.
Assume and resolve escalated claim and inquiries from team members. Serves as back-up for team members, or Leadership.
Coach and mentor less experienced team members on claims handling, resource utilization, and appropriate resolutions.
May include call center responsibilities, including adhering to call center standards.
Assist in training new team members as needed and providing feedback to Leadership.
Various research projects for Sr. Management and Clients, as assigned.
Collaborate, coordinate, and communicate across disciplines and departments.
Ensure compliance with HIPAA regulations and requirements.
Demonstrate Company's Core Competencies and values held within.

Benefits

Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off -- accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Summer Hours
Sick time benefits -- for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits