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 :

• High School or GED equivalent.
• Customer Service experiences in a transaction-based environment such as a call center or

retail location preferred, demonstrating ability to be empathetic and compassionate.

Healthcare Call Center Representative Benefits :

• Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

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