Claims Inquiry Unit Representative
Posted 2025-03-15Summary:
To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties.
Duties and Responsibilities:
Be proficient in discussion and execution including, but not limited to, the following:
? Multi-Task in a very busy Call Center Environment
? Explanation of how the plan works and how to utilize the service
? Explanation of the Claim process, payment, denials, etc..
? Explanation/Assist with Benefit clarification, eligibility, verification, and claim status
? Participate as a team player by demonstrating support to peers, management, and the department's goals
? Attend meetings and training sessions as scheduled
? Assist with training new employees as needed
? Show flexibility in meeting performance objectives consistent with IPA and department objectives
? Document all Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.
? Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal.
Minimum Job Requirements:
? High school diploma.
? Two years of Customer Service/Telemarketing sales or related experience.
? Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10
Skills and Abilities:
? Must be computer literate, typing 30 wpm
? Excellent telephone techniques
? Excellent interpersonal and communication skills; strong writing skills
? Medical Front and Back Office as well as Claims/Billing experience preferred
? Bilingual in Spanish preferred
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