SUMMARY: This position is responsible for managing all incoming telephone calls and general correspondence received from members of our Client’s health plan and the providers who render treatment to these members.

DUTIES AND RESPONSIBILITIES:

· Provides quality and professional customer service to members and providers, including use of proper telephone etiquette.

· Responds to all communications received in a timely and professional manner.

· Educates members and providers about healthcare benefits.

· Resolves claim issues or concerns that may arise, including the following:

o Initiates requests for stop payments, re-issues, and/or check forgery.

o Initiates recalculation requests after verifying that benefits were incorrectly paid.

o Initiates pricing requests with the network when necessary.

o Forwards additional information to Claims Examiners for claims reprocessing when necessary.

o Researches entire file to ensure that all issues are addressed.

o Ensures follow-up on all claims issues that need resolution.

· Brings issues to the Supervisor’s attention.

· Assists new CSRs with taking calls by shadowing.

· Assists as a backup the Provider Maintenance Specialist by accurately maintaining the integrity of our provider records and updating as needed.

· Provides backup in other areas, based on business needs.

· Assists as a backup all dental fax backs to provider.

· Assists as a backup for all faxes received by Chesterfield Resources.

· Performs other related duties as assigned by management.

QUALIFICATIONS:

· High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.

· Previous experience in a call center or customer service role is preferred, but not required

· Certificates, licenses and registrations required: None

· Computer skills required: Microsoft Office Suite

· Other skills required:

o Demonstrate a positive and cooperative work attitude, encourage teamwork among fellow employees and customers.

o Must be able to communicate effectively with clients, claimants and professionals.

o Must be proficient in Windows operating systems, or equivalent, and have basic computer skills including data entry.

o Must be organized, have the ability to multi-task, work independently and problem solve.

HYBRID SCHEDULE: Training up to ninety (90) days full-time in office (Monday through Friday). OPTIONAL Hybrid Schedule upon completion of (90) day training period and successfully meeting all benchmarks (audit accuracy and call times). Hybrid is considered three (3) days at home and two (2) days in office. Hybrid Schedule is contingent upon performance and business needs.

If you are a motivated individual with a passion for customer service and enjoy working in a dynamic team environment, we would love to hear from you. Apply now to join our call center team!

Job Type: Full-time

Pay: $15.00 - $16.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance

Compensation package:

• Bonus opportunities

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No nights
• No weekends

Application Question(s):

• Do you have reliable transportation?

Experience:

• Call center: 1 year (Required)
• Health Insurance Verification: 1 year (Preferred)

Work Location: Hybrid remote in Uniontown, OH 44685