Position : Customer and Claims Support Tech I Location : Spartanburg, SC

Job Id : 192 # of Openings : 1

Job Summary

The Customer and Claims Support Tech I will support customers by providing helpful information, answering questions, and responding to complaints.

They are the front line of support for clients and customers, and they help ensure that customers are satisfied with products, services, and features.

Will also assist with monitoring claim and user activity and identifying and resolving claim processing issues, both internal and with customers.

Key Duties

• Answer customer service phone calls.
• Respond to inquiries submitted via email or otherwise by customers.
• Provide external training of the program to providers as needed, using tools like WebEx, Microsoft Teams, etc.
• Research, identify, resolve, and escalate customer service inquiries as needed.
• Track and report internal claims or system-related issues as needed.
• Assist with monitoring daily claims activity and assist with resolving claim rejections and denials.
• Participate in company meetings.
• Performs other duties as assigned by RedSail Technologies management.

Education / Training

• High school diploma or general education degree (GED).
• Pharmacy Technician Certificate desired but not required.
• PMS / EMR system and customer support experience preferred.
• PBM and / or medical plan provider claims support experience desired.
• Pharmacy Technician Certificate desired but not required.

Required Work Experience / Skills

• Must have pharmacy and medical billing software experience.
• Must have excellent computer skills and medical terminology knowledge.
• Must have knowledge of insurance billing standards for medical and pharmacy services.
• Must be able to effectively manage multiple priorities.
• Must be a problem solver with the ability to identify and resolve discrepancies and errors.
• Must have excellent communication, customer service, and interpersonal skills.
• Must have expertise in Excel and Word, with the ability to manage and maintain multiple detailed worksheets.

Preferred Work Experience / Skills

• Excellent written, verbal, and presentation skills.
• English is required, the ability to speak Spanish is preferred.

Discretionary Judgment

• Uses independent judgment and discretion based on the employee’s experience in the position and knowledge of the products, equipment, and services
• Uses good judgment and possesses ethical work values

Physical Demands, Working Conditions, and General Employment Guidelines

• Moderate levels of stress may be experienced in the performance of the job
• Position is performed in a general office environment, home office, or approved remote workspace where physical work includes, but is not limited to, sitting, standing, reaching, kneeling, bending, and lifting to 25 lbs.

Equipment

• Must have internet access.

Safety to Self and Others

Little responsibility for the safety of others. Job is performed in an office setting where there are no hazardous materials or equipment

Working Conditions / Hazards

Position is performed in an open office environment or approved remote work location

Work Location

• Spartanburg, SC

Last updated : 2024-05-17