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Job Title : Healthcare Call Center Representative
Pay : $22.99 an hr Bi-weekly
Job Type : Must Live in Oklahoma for job to be Remote.
Shift Options :
Between 8am - 5pm M-F
Healthcare Call Center Representative Overview :
Answers questions and resolves issues based on phone calls / letters from members,
providers, and plan sponsors.
Triages resulting rework to appropriate staff.
Documents and tracks contacts with members, providers, and plan sponsors.
The CSR guides the member through their members plan of benefits, Aetna policy and procedures
as well as having knowledge of resources to comply with any regulatory guidelines.
Creates an emotional connection with our members by understanding and engaging the
member to the fullest to champion for our members' best health.
Taking accountability to fully understand the member’s needs by building a trusting and
caring relationship with the member.
Anticipates customer needs.
Provides the customer with related information to answer
the unasked questions, e.g. additional plan details, benefit plan details, member self-service
tools, etc.
Uses customer service threshold framework to make financial decisions to resolve
member issues.
Explains member's rights and responsibilities in accordance with contract.
Processes claim referrals, new claim handoffs, nurse reviews, complaints
member / provider), grievance and appeals (member / provider) via target system.
Educates providers on our self-service options; Assists providers with credentialing and
recredentialing issues.
Responds to requests received from Aetna's Law Document Center regarding litigation;
Lawsuits.
Handles extensive file review requests.
Assists in preparation of complaint trend reports. Assists in compiling claim data for
customer audits.
Determines medical necessity, applicable coverage provisions and verifies member plan
eligibility relating to incoming correspondence and internal referrals.
Handles incoming requests for appeals and pre-authorizations not handled by Clinical
Claim Management.
Performs review of member claim history to ensure accurate tracking of benefit
maximums and / or coinsurance / deductible. Performs financial data maintenance as
necessary.
Uses applicable system tools and resources to produce quality letters and spreadsheets in
response to inquiries received.
Healthcare Call Center Representative Qualifications :
retail location preferred, demonstrating ability to be empathetic and compassionate.
Healthcare Call Center Representative Benefits :
How to Apply :
If you are interested in this position, please apply OR submit your resume to :
Saw Hlaing shlaing@alinestaffing.com 412-790-5425
Last updated : 2024-04-27
Full Time
Business Services
$37k-47k (estimate)
04/28/2024
05/07/2024
alinestaffing.com
MOUNT PROSPECT, IL
200 - 500
2005
RAYMOND LICHOCKI
$10M - $50M
Business Services
The job skills required for Call center representative include Customer Service, Call Center, etc. Having related job skills and expertise will give you an advantage when applying to be a Call center representative. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Call center representative. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Call center representative positions, which can be used as a reference in future career path planning. As a Call center representative, it can be promoted into senior positions as a Contact Center Representative IV - Inbound that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Call center representative. You can explore the career advancement for a Call center representative below and select your interested title to get hiring information.
If you are interested in becoming a Call Center Representative, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Call Center Representative for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Call Center Representative job description and responsibilities
Call center representatives must be professional throughout each phone call and to other call center employees.
02/12/2022: La Crosse, WI
Therefore, call center representatives should be open to work rotational shifts and adapt to a flexible work schedule.
01/09/2022: High Point, NC
A successful Call Center Representative must have an excellent attitude towards their work and empathy for their customers' needs.
12/14/2021: Galveston, TX
The representatives should also use their problem-solving skills to resolve customer queries effectively.
01/05/2022: Sioux City, IA
The Call Center Customer Service Representative must be able to deliver outstanding customer service to ensure customers receive the best customer service experience.
12/26/2021: Greensboro, NC
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Call Center Representative jobs
Working as a call center representative requires a fast typing ability.
12/22/2021: Orange, CA
Perfect for Call Center Representatives with two to five years of experience.
12/20/2021: Roanoke, VA
Due to the sensitivity of the call type, all representatives will be required to pass a Personnel Security suitability determination and adhere to strict privacy policies.
02/10/2022: Greenville, MS
Excellent follow through skills, responding timely to phone calls, tasks, and projects; accuracy and attention to detail are a must.
02/28/2022: Jamestown, NY
Previous call center experience preferred but not required.
12/17/2021: Greenville, MS
Step 3: View the best colleges and universities for Call Center Representative.