Claims Examiner - Liability

SGS-Service Center Representative

Location: Bethesda, MD Remote Duration: 3 Months (90 DAYS) Pay Rate: $17 - $18/hr on W2 Shifts: 8am-4:30pm EST and 10:30am -7pm EST Requirements: Claims and customer service is priority for experience, Spanish speaking will be a plus, not mandatory All candidates must be able to work a set shift: 8am-4:30pm EST and 10:30am -7pm EST Duration 90 day, with the option for extension Location Remote

Description: The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative expedites the claims process and provides detailed claim notes on all calls; as well as resolves issues and directs calls to an appropriate escalation path as needed.

Job Description Essential Functions Duties and Responsibilities

Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims process and servicing processes. Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status. Educates members and providers on client requirements and benefit plans documenting all required details of the call in a concise professional manner. Enters verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system. Assigns new claims to the appropriate claims handler. Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. Attendance during scheduled work hours is required.

Education

High School diploma or GED required. College courses preferred.

Experience

One (1) year of customer service and claims experience or an equivalent combination of education and experience is required. Inbound call center experience preferred.