This position is forCare1st Health Plan in Phoenix, a WellCare Healthplans, Inc. company.
Answers incoming provider calls regarding claim status. Provides excellent customer service including a positive attitude, the ability to identify root cause issues and education and resolution to provider inquires in a timely and accurate manner. Ensures all calls received are properly inputted into the phone tracking system and follow-up is performed to fully resolve claim issues. Provides feedback regarding trends and training needs within the Claims Department to improve accuracy of claims processing and processing claims and/or assisting with reports in between calls.
Reports to: Mgr, Claims
Location: Camelback Rd, Phoenix AZ 85016
Job Type: Hourly/Non-exempt
- Answers all incoming provider calls in a timely, efficient and knowledgeable manner.
- Provides excellent customer service to external and internal customers.
- Reviews provider claim requests for appropriate information and accurate reimbursement.
- Accurately routes claims requiring adjustments for correction.
- Researches and follows up on claim adjustment requests to ensure first call resolution.
- Accurately adjudicates claims in accordance with health plan guidelines, company standards, and company procedures in between calls.
- Properly documents all incoming calls to the phone tracking system.
- Reviews history of claim in question, researches particulars and contacts appropriate personnel to verify information.
- Identifies trends and processing issues related to the rework of claims.
- Prioritizes and manages individual workflow as need.
- Performs other duties as assigned.
- Required A High School or GED
- Required 2 years of experience in customer service
- Preferred 2 years of experience in claims processing (Medicaid and Medicare a plus)
- Intermediate Ability to multi-task
- Intermediate Ability to work as part of a team
- Intermediate Demonstrated customer service skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated follow up skills
- Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Beginner Demonstrated written communication skills
- Beginner Demonstrated organizational skills
- Beginner Knowledge of healthcare delivery
- Required Beginner Microsoft Word
- Required Beginner Microsoft Outlook
- Required Beginner Microsoft Excel