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Keystone Mercy Health Plan is Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan serving more than more than 273,000 Medical Assistance recipients in Southeastern Pennsylvania. Located in Delaware County, Pennsylvania in close proximity to the Philadelphia International Airport, Keystone Mercy Health Plan is a mission-driven, health care ministry of the Sisters of Mercy with more than 24 years of Medicaid Managed Care experience. Its corporate parent partners are Mercy Health System and Keystone First, a subsidiary of Independence Blue Cross.
Keystone Mercy is a member of the AmeriHealth Mercy Family of Companies, the largest multi-state Medical Assistance managed care organization in the country serving more than 2.7 million members nationwide.
Learn More about Keystone Mercy
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| Company: |
Keystone Mercy |
Required Education: |
Not Specified |
| Job Type: |
Health Care Insurance |
Required Experience: |
At least 2 year(s) |
| Base Pay: |
N/A |
Required Travel: |
Not Specified |
| Other Pay: |
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Location: |
US-PA-Philadelphia
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| Employee Type: |
Full-Time |
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| Manages Others: |
No |
| Relocation Covered: |
Not Specified |
| Industry: |
Healthcare - Health Services Insurance |
| Reference ID: |
3783*JR |
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Responsible for assisting the supervision of operations supporting claims, provider claim service, enrollment or phone staff in a call center environment. Analyzes existing queues or calls in queue and methods to promote effective operations through standardization and improvement. Triages all complex inquires and correspondence submitted internally or by the client. Supports the supervisor and manager with reports, special processes, projects, etc. Functions as a technical specialist, analyzes complex operational problems, and provides technical solutions. Maintains a current working knowledge of claims processing rules, contractual guidelines, plan policies and operational procedures to effectively provide technical expertise. Resolves and provides direction on complex cases utilizing strong investigative and research skills. Identifies and recommends areas where changes to existing processes and procedures can result in improving efficiency and/or cost savings. Provides support to Customer service representatives and assists when claims call center is backlogged. Delegates work appropriately to staff; ensures the volume of work produced meets or exceeds service standards and quality expectations. Demonstrates the ability to lead, resolve conflicts and plan solutions. This may include leading certain meetings as needed. Maintains a balance of productivity, quality and timeliness of job accountabilities.
Associates Degree required (or equivalent course work or work experience). Bachelor’s degree preferred. Experience: Minimum of 4 years work experience in relevant area of assignment claims processing health and dental claims with at least one (1) year Research Analyst experience. Healthcare or Managed Care experience preferred. In-depth knowledge of claims adjudication and medical terminology. Knowledge of call center and customer service operations. Working knowledge of PC applications in a windows based environment.
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