Responsible for functioning on a learning curve to become fully proficient in all aspects of customer service, claims and/or membership issue resolution. Performs research and analysis, advocating on behalf of customers through whole case methods. Learns to provide full service to members, providers, group administrators, and brokers by processing health care claims, handling inquiries, and/or performing membership functions. Performs at least two of the three functions routinely. Primary duties may include, but are not limited to: Receives inbound telephone calls or paper and electronic claims from members and providers. Resolves issues for members, providers, group administrators and brokers. Analyzes the situation and completes research to ensure no rework or follow-up issues. Applies knowledge of policies and procedures, products, legislation and claims workflow. Interacts with systems to ensure claims are paid or denied based on terms of contract. Requires HS diploma or equivalent; 3-6 months experience in an automated customer service environment; demonstrated ability to listen effectively, use probing skills to obtain relevant information and establish rapport quickly with customers and co-workers; or any combination of education and experience, which would provide an equivalent background.
The day is spent on the phones answering calls from Dr. offices and facilities, answering questions re: claim status, eligibility.
Monday-Friday 8:30-5:00 (no other shift). Training shift is the same. In classroom training for 6 weeks followed by 1 week of nesting on the floor with a senior team member.
There are 6 FT positions open - those who are a good fit and have good attendance can be considered for hire. Metrics – average speed to answer 2.5 minutes. Adherence to their schedule more than 90% of their day – breaks and lunches on time. Average handle time – 600 seconds. After call work usage. Attendance policy – no time off during training – the first 7 weeks (impossible to catch them up). First 90 days after training - 1 verbal, 2 written, 3 termination. After the first 90 days - 7 verbal, 8 written, 9 termination on rolling calendar year. Small team – huddle rooms, hangout areas, coffee room, very nice team. Onsite interviews – 30 minutes. Closed Thanksgiving and the day after. Business casual dress code – no sweatshirts, tank tops, or hats. Very fast paced.