Receive and respond to inbound phone calls
Respond to outbound phone call requests
Document all calls in ticketing and tracking systems
Respond to customer inquiries and provide data to customers within a required time frame
Act as liaison between claims department and providers
Research customer claims in the primary payor systems
Ensure highest level of customer service on every call

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need:

High school degree required; Bachelors degree preferred with three (3) plus years of relevant professional experience in Healthcare claims operations for a large national/regional or Blues health plan or insurance company and/or TPA.
Previous Health Care Call Center/Customer Service Experience.
Desired Skills include: Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10.
Experience with UB/Institutional (UB04); Professional (CMS1500) claims and HIPAA-compliant EDI formats for claims related exchanges. Understand CMS guidelines for claims processing.
Must be able to work with minimal supervision.
Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts.
Excellent verbal and written communication skills.
Attention to detail and problem solving skills
Proficiency with MS Office applications, especially Word and Excel.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. We provide a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote