Claims Inquiry Unit Representative

Summary:

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

Apply Job!

For more such jobs please click here!