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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.
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.
Additional Responsibilities:Candidate Education:
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
Beginner Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Beginner Demonstrated organizational skills
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Beginner Knowledge of healthcare delivery
Intermediate Other Demonstrated follow up skills
Licenses and Certifications: A license in one of the following is required: Technical Skills: