Claims Customer Service Representative
Assist providers with inquires specific to their medical claims.
Essential Functions & Responsibilities
- Provide claims information through telephone inquiry from providers of service.
- Provide claim information through inquiries receive via facsimile from providers of service.
- Recognize potential problems and refers them to the appropriate person to include Claims Management for resolution, and follows up to assure resolution
- Maintains a broad knowledge of all systems used in the adjudication of claims.
- Maintains quality standards of claims calls handled.
- Maintain a log of calls for use in the reporting and tracking of calls handled.
- Liaison to other departments outside of the claims department.
- Provides back-up to the Claims Department staff, (claims examiners, data entry & clerical)
- Special projects and other duties as assigned by management.
- Some overtime may be required.
- Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
- Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
- Ability to come to work and work the regular schedule and shift for the position.
- Compliance with all personnel policies and procedures.
- Perform additional duties and related essential duties as assigned.