Job Summary
The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative expedites the claims process and provides detailed claim notes on all calls; as well as resolves issues and directs calls to an appropriate escalation path as needed. Essential Functions Duties and Responsibilities
Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims process and servicing processes.
Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status.
Educates members and providers on client requirements and benefit plans documenting all required details of the call in a concise professional manner.
Enters verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system.
Assigns new claims to the appropriate claims handler.
Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. Attendance during scheduled work hours is required.
Performs other duties as assigned.
Supports the organization's quality program(s). Requirements:
Start date January 29, 2024
Shift will be 8:30 5:00 pm EST and 8:00a- 430pm
Duration 90 day, with the option for extension
Location - Remote
Education High School diploma or GED required.
College courses preferred.
Experience One (1) year of customer service experience or an equivalent combination of education and experience is required.
Inbound call center experience preferred. Other Skills and Abilities
Knowledge of medical terminology Understanding of claims management
Excellent oral and written communication PC literate, including Microsoft Office products.
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Ability to multitask in a fast-paced environment
Ability to support multiple clients across communication channels and utilize multiple systems simultaneously
Ability to work in a team environment and/or independently.
Ability to meet or exceed Performance Competencies Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
