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.
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.
M-F 7am - 7pm (8hr shift determined during training)
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.
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Since 1964 On a journey around the world during the early 1960s, Bernard "Bernie" Howroyd had to work odd jobs in order to pay his way forward—selling encyclopedias in Australia to chocolates in Canada. Through these varied encounters, an incredible insight started to form in young Bernie’s mind: “No matter where people are from, no matter what language they speak, everyone deserves to be heard and respected.” Inspired and driven by this realization, he took that insight and started AppleOne Employment Services in Los Angeles in 1964. Hiring Made Human We at AppleOne have one true belief. We believe in people. Since 1964, we have connected the best people, their talents, skills, career goals, and aspirations with the best companies. We are "Career Gurus." We are "People-People." Let us introduce you! AppleOne is part of the ActOne Family of Companies. Across our company groups—A-Check Global, AgileOne, and ATIMS—we are able to provide comprehensive services and technologies to our enterprise partners. Our integrity and quality of service is recognized by our ISO-9001:2008, IMAGE, and WMBE Certifications. We have serviced Federal government over the years (including direct with FEMA). We are DCAA compliant. Recently, we formed a new corporation (ActOne Government Solutions, Inc.) specifically to service Federal government contracts.