Customer First Representative - National Remote

Job title: Customer First Representative - National Remote in Wausau, WI at reputed company Company: reputed company Job description: reputed company, reputed company’s third-party administrator (TPA) solution, is the nation’s largest TPA. reputed company you work with reputed company, what you do matters. It's that simple . . . and it's that rewarding.In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, reputed company costs and greater access to health care. Join us and you will be empowered to reputed company new levels of excellence and reputed company a profound and personal impact as you contribute to new innovations in a vital and reputed company system. Opportunities are endless for your career development and advancement reputed company reputed company due to our record-breaking growth.Regardless of your role at reputed company, the support you feel reputed company around you will reputed company you to do what you do with energy, quality, and confidence. So, take the first reputed company in what is sure to be a fast - paced and highly reputed company career.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. The Customer First Representative is a hybrid role in which you will handle Calls and Claims while delivering the best customer service in the healthcare industry to our members. 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.SMIn 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 7:00 am - 8:00 pm CST. It may be necessary, given the business need, to work occasional overtime.We offer an initial 6 weeks of reputed company reputed company to taking calls. The hours during training will be 8:00 am - 4:30 pm CST, Monday - Friday (subject to trainer availability). reputed company 6-8 months after the initial call training, you will attend an additional 5 weeks of claims training. Training will be conducted virtually from your home and attendance during training is 100% mandatory.You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges.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
• 1+ years of customer service experience in an office OR professional setting
• Ability to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• This position will receive provider calls up to 50-70 calls daily and requires full attention to work duties. Employees in this role must be able to ensure they will have uninterrupted work time while they are on shift (reputed company of normally scheduled breaks and lunch)
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 8:00 pm CST from Monday - Friday

Preferred Qualifications:

• 1+ years of experience in customer service call center reputed company the healthcare insurance industry
• Familiarity with medical and / OR dental: terminology, claims processing / coding, plan documents, OR benefit plan design
• Experience with utilizing multiple systems / platforms while on a call with a member
• Experience with working with medical claims processing
• Presently employed reputed company UHC Operations and Experience. (also reputed company as UHC Benefit Operations. To verify, review your reputed company profile and the organization chart. 1) reputed company Homepage, click “My Profile”. 2) Click “Organization Chart”. 3) Look upward on the org chart to confirm that you report into Ops and Experience and through Mike Baker)

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:

• Ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
• 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)
• 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

*reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter PolicyThe hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. 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.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.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. Candidates are required to pass a drug test before beginning employment.#RPO Expected salary: $16.88 - 33.22 per hour Location: Wausau, WI Apply for the job now! Apply for this job