Claims & Customer Service - Los Angeles Ca.
$56k - $65kCareer Strategies Inc
Claims and Customer Service Position Overview
This role is customer-facing and is considered a key customer service representative for the Health Organization. The Claims Specialist/Analyst will process health insurance claims and answers calls from the customer (participant members, providers, physicians, hospitals etc.) Adhere to eligibility, claims and call policies and procedures while making sound claim/call decisions. Foster strong relationships through the resolution of customer incoming call requests. Serve our customers by determining requirements, answering inquiries, resolving problems, and fulfilling requests.
This is a Hybrid position, and it will be rare that you have to work onsite. Most of it is remote work, but you still have to live in the Los Angeles County CA area to be considered.
Responsibilities
Elevate and enhance the Health Organizations reputation by providing "World Class Customer Service" of the phone in a "high-call-volume" position.
Answer incoming phone calls from customers and identify the type of assistance the customer needs (e.g. benefit and eligibility, billing and payment inquiries, authorizations for treatment and explanation of benefits (EOBs))
Communicate and collaborate with customers to resolve issues, using clear, simple language to ensure understanding
Review and research incoming healthcare claims by navigating multiple computer systems and platforms and verify the data/information necessary for processing (e.g. pricing, prior authorizations, and applicable benefits)
Ensure that the proper health benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, federal mandates, CMS/Medicare guidelines, and benefit plan documents/certificates)
Qualifications and Education Requirements
Must have a Bachelor's Degree in Healthcare, Math, Engineering or related field, or equivalent work experience
Minimum of four (4) years of claims processing preferred
Minimum of four (4) years in heavy call center required
Demonstrate adaptability and forward-thinking in the face of technological or organizational change
Proficient with Microsoft products, including Word, Excel and Outlook
Excellent customer service and telephone skills
Excellent verbal and written communication skills
Knowledge of medical terminology
Ability to research and verify claims payment, benefits, and eligibility issues
Strong knowledge of benefits plans, policies and procedures
Company Benefits
Salary range offered $56,000-$65,000 to start
Medical, Dental & Vision Health Insurance is paid 100% by Employer (you can add up to 5 dependents for health coverage, and it costs $50 a month total for dependents coverage).
401K with 2% Employer Match
Employer Pension! Vested after 5 years
PTO- 2 weeks 5 weeks of time off depending on your years with the company
Holiday Pay -2 Floating Holidays & you get your Work Anniversary off every year
Sick Pay 12 days a year
Career advancement opportunities & the ability to work for a very reputable and longstanding organization.
Equal Opportunity Employer
Career Strategies$25 - $40 per hour
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