Claims Resolution Expert
3 days ago
About the Position
We are seeking a skilled customer service representative to join our team, providing exceptional service to healthcare providers.
Key Responsibilities:
- Communicate with healthcare providers to resolve claims issues and provide information on member eligibility and benefits.
- Assist providers with navigating the provider portal, including setting up accounts, troubleshooting, and retrieving necessary information.
- Handle claim status inquiries, research, and facilitate resolution of payment issues; provider education on remittance advice interpretation and reimbursement.
- Work closely with the Claims Team in resolving claims discrepancies, inappropriate denials, and delays in payments.
- Provide providers with eligibility, process authorizations, and exception requests.
- Answer questions regarding authorizations and denials.
Requirements:
- Excellent customer service skills, including ability to diffuse difficult situations.
- Strong analytical and problem-solving skills, with the ability to analyze complex claims data/payments and clearly communicate findings to providers.
- 1+ year(s) of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English.
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