This position has responsibility of answering incoming calls from providers and members as they relate to eligibility, benefits, claims, coverage and authorization of services. This position will also problem-solve and explain programs and procedures to callers and will answer/address claim payment questions with providers.
Primary duties include the following:
Able to deal effectively with customers on a one -on - one basis and demonstrate appropriate customer care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
with customers (internal and external)
by understanding inquiry and provide accurate and timely responses about benefits, authorizations, services and claims.
Gather information, research, resolve inquiry and
record in customers account / health plan database system.
Communicate appropriate options for resolution in a timely manner and escalates inquires to appropriate staff as required.
Uses, protects and discloses members protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Must have the ability to learn quickly, deliver high quality customer service and thrive in a production-based environment where first call resolution is a must.
Must be customer service oriented team player, focused, articulate and possess good phone etiquette. Must maintain member and provider confidentiality at all times, demonstrate effective problem solving skills and be punctual and maintain good attendance. Be able to demonstrate computer proficiency and the ability to maneuver and navigate between computer screens and programs.
Critical thinking/problem-solving, judgment and decision making skills, strong 10-key data entry and general numerical analytical skills required.
Bilingual English / Spanish required
High school diploma or
Must have a minimum of two years of claims and customer service experience preferably in a Commercial healthcare environment.
Working knowledge of Microsoft Office.
Proficient in ICD-9, CPT, and HCPCS coding.
Associates Degree in Healthcare, Sales, or Business
Abrazo Health Care - 13 months ago
Abrazo Health Care is an award-winning health care system, operating an array of hospitals, specialty institutes, a medical group, health...