Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Provide excellent customer service primarily by telephone to all PSA customers, members and group administrators. Assist with coverage-related questions by analyzing customer inquiries and determining steps for resolution.

Primary job function is to answer telephone inquiries, but additional duties include assisting walk-in customers, sorting and responding to inquiries received by mail / email in a professional manner, processing claims, posting refunds, auditing accounts, completing stop payments, and assisting in other areas as needed.

Essential Responsibilities :

• Provide excellent customer service. Expectations include demonstrating the following : high level of customer focus, effective listening, problem ownership, an aptitude for learning, attention to detail, productivity and efficiency with subsequent follow up, reliability and conscientiousness.
• Accurately process claims by researching benefits and claims policy and procedures. Research includes, but is not limited to : reading and understanding all related account and claim notes, comparing procedures to diagnostic codes, determine eligibility based on service date and plan parameters, accurately enter claims to prevent duplicate reimbursements or overpayments, review claims for inconsistencies between billed and election amount, and adjudicating point of sale transactions.
• Exhibit energy and enthusiasm while assisting members and group administrators with coverage-related questions. Accurately interpret benefit and group plan documents for groups.
• Analyze customer inquiries and determine steps for resolution. Research member files, regulatory guidelines, policy and procedure documentation, and / or personnel to determine that information quoted to callers is correct and claims have been processed accurately.

• Communicate and document information in a professional, clear, consistent, and accurate format.
• Relay information to appropriate departments and personnel using established communication channels and procedures.
• Complete appropriate research and follow-up for prompt resolution of disputed claims.
• Prepare written correspondence using system generated reports and word-processing system. Prepare reports using spreadsheet software.

Supporting Responsibilities :

• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Follow department and company-wide policies and procedures.
• Meet department and company performance and attendance expectations.
• Participate in departmental meetings, training, and takes advantage of opportunities to increase knowledge and skills.
• Perform other duties as assigned.

Work Experience :

A minimum of 1 year medical insurance, other healthcare related field, call center or customer service experience required.

CPT / ICD-10 coding preferred.

Education, Certificates, Licenses :

Requires high school diploma or GED.

Knowledge :

Working knowledge in the areas of medical terminology and medical coding. Goes "above and beyond" to assist callers by making their satisfaction a high priority.

Ability to navigate through multiple software systems while talking on the phone. Advanced PC skills, ability to type using a standard keyboard and operate a 10-key pad accurately.

Ability to work under time pressures and deal with emotional customers. Understand the importance of courtesy to internal and external customers.

Competencies :

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment :

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 2% of the time.

Skills :

Accountability, Collaboration, Communication (written / verbal), Flexibility, Group Problem Solving, Listening (active), Organizational skills / Planning and Organization, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.

Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.

Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.

It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.

Last updated : 2024-05-15