Customer Service Representative - Part-Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Our client is currently seeking a 2 Part-Time Customer Service Representatives in High Point, North Carolina. The work schedule is Monday - Friday 5-9pm. Main Duties: Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors Triages resulting rework to appropriate staff Documents and tracks contacts with members, providers and plan sponsors Explains member's rights and responsibilities in accordance with contract Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues Responds to requests received from the company's Law Document Center regarding litigation; lawsuits Handles extensive file review requests Assists in preparation of complaint trend reports Assists in compiling claim data for customer audits Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible Performs financial data maintenance as necessary Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received Customer Service Representative Qualifications: Experience in a production environment Customer Service experience in a transaction based environment such as a call center or retail location preferred Ability to multi-task to accomplish workload efficiently Analytical skills Ability to maintain accuracy and production standards Technical skills Oral and written communication skills Understanding of medical terminology Problem solving skills Attention to detail and accuracy Negotiation skills High school diploma or equivalent
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