The Customer Service Representative supports the Medicare Appeal process by handling incoming calls, resolving customer inquiries, complaints, and requests while adhering to internal policies and procedures.
They develop and maintain knowledge of organizational policies, procedures, and services, utilizing automated systems for data entry and retrieval.
Responsibilities include responding promptly and courteously to inquiries via phone, email, fax, or mail; investigating and resolving issues; and escalating complex cases when necessary.
They serve as a liaison between supervisors and external providers, maintain call logs, and ensure accurate documentation.
Required qualifications: High School diploma or equivalent, 2+ years of customer service experience in a call center or similar setting, effective communication skills, and ability to research Medicaid-related issues.
Preferred qualifications: Medical office experience, knowledge of Medicaid eligibility, CPT and HCPCS codes, and proficiency in Microsoft Office.
Skills: Education, MS Office, Medical knowledge.