Customer Service Representative I - Claims, Geisinger Health Plan (work from home Pennsylvania resident)

Job Summary

Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service - Claims. Actively participates in cross training, improving processes within the Customer Service team.

Job Duties

• Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
• Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
• Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors.
• Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
• Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules.
• Determines the eligibility of most members as well as processing terminations and disenrollments.
• Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity.
• Determines if services received are covered benefits as applicable by line of business and product design.
• Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
• Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
• Provides daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.
  
  

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details

Work At Home Requirements

To ensure a productive and secure remote work environment, the following conditions must be met:

• Quiet, Dedicated Workspace: A private, distraction-free area within your home to support focused work.
• Adequate Workstation Setup: Sufficient space to accommodate all employer supplied equipment, including monitors, keyboard, and other peripherals.
  
  

High-Speed Internet Connection

Connection Type: Cable modem only (DSL, wireless cellular, and satellite services are not permitted).

Minimum Speed Requirements

• Download: 75 Mbps
• Upload: 25 Mbps
• Ping: Less than 150 ms
• Jitter: Less than 30 ms
• Connectivity: The computer must be connected via Ethernet cable. Wi-Fi is not permitted unless a Virtual Private Network (VPN) is used to secure the connection.
  
  

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 1 year-Customer Service (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.