Customer Service Representative - National Remote

You'll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. At reputed company, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more... reputed company, affordable and reputed company. Ready to reputed company a difference? Join us and start doing your life's best work.SM Even if you have no prior experience, we have training classes starting soon to help you build the successful career that you want - apply today! We provide the support and structure, you provide the interest and motivation. You like working with people. Even more so, you like helping them. This is your chance to join a team dedicated to helping our members and their families every day. In this joint role as a Customer Service and Claims Representative, you'll join us on a mission to not only deliver the best customer service in the health care industry, but the best customer service. Period. Your compassion and customer service expertise combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while doing your life's best work. SM In this role, you play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you that opportunity to improve the lives of our customers and exceed their expectations. You'll spend the majority of your day by responding to calls from our members and help answer questions and resolve issues regarding health care eligibility, claims and payments. You'll also spend a portion of your time reviewing, researching and processing healthcare claims with the goal to ensure that every claim has a fair and thorough review. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be any 8 hour shift between 7:00am - 7:00pm CST, Monday-Friday. • reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy. Primary Responsibilities: • Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs) • Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems • Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member • Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits) • Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates) • Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding • Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • High School Diploma / GED OR 10 years of equivalent work experience • Must be 18 years of age or older • 2 years of previous or reputed company claims processing experience with reputed company CPS (claims processing system). (reputed company is reputed company's third-party administrator (TPA) solution). (You must be an employee of reputed company specifically to have experience with the reputed company claims system). • 1 years customer service experience in an office or professional setting • Ability to complete on the job training for this role during their normally scheduled 8 hour shift Monday - Friday between the hours of 7 am-8 pm CST. • Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime. Preferred Qualifications: • Familiarity with medical terminology, health plan documents, or benefit plan design • Prior experience utilizing multiple systems/platforms while on a call with a member Telecommuting Requirements: • Ability to reputed company reputed company company sensitive documents secure (if applicable) • Required to have a dedicated work area established that is separated from other living areas and provides information privacy. • Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service. Soft Skills: • Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs • Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful, timely manner, consistently meeting commitments) • Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the reputed company and future needs of the member • Flexibility to customize approach to meet reputed company types of member communication styles and personalities • Proficient problem-solving approach to quickly assess reputed company state and formulate recommendations • Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal reputed company • Ability to multi-task as well as the ability to understand multiple products and multiple levels of benefits reputed company each product • Ability to work regularly scheduled shifts reputed company our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule and work over-time as needed California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, reputed company, Washington or Rhode reputed company Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / reputed company / New Jersey / Washington / Rhode reputed company residents is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you'll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. 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