Receive, answer and/or record telephone/correspondence/e-mail inquiries from subscribers, providers, and other consumers relating to areas of coverage, payment of claims, membership status, medical management intake calls, etc., under the various EmblemHealth medical/surgical, dental, hospital and Medicare plans.
Review inquiries, correspondence and email receipts. Prepare email resolutions, letters (form or narrative letter) and/or claims payment process adjustments.
Perform written and verbal duties of the position to meet company goals for production and accuracy.
Perform related claims approving and clerical work as assigned.
Perform other duties as assigned or required.
Must be able to work under pressure, handle stressful situations effectively and deal politely with subscribers and providers on the telephone, in person, and email/correspondence
Ability to detect and relate problem service issues to management
Ability to speak well on the telephone and maintain a positive telephone personality.
Must be able to compose clear concise letters
If designated, sort and screen correspondence receipts and resolve via coding of additional payment, possibly including salvage and/or completion by letter
Typing and PC skills
Ability to adapt to change and address multiple issues simultaneously
Good organizational skills
Must be available for training
Regular attendance is an essential function of the job
Bilingual – Spanish required
Education and Experience:
A minimum of two (2) years’ experience in customer service; one year must be in a call center setting. A college degree is preferred. Health insurance experience is a plus.
Online: Reading Comprehension
Online: Customer Service
Oral Telephone Simulation; Interview
An Equal Employment Opportunity Employer M/F/H/V
Recruitment may also be conducted externally to obtain the best-qualified candidates
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Job ID: 190RD
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