Claims Customer Service Representative- #26-19638

Job Title

Duration: 3 months

Job Description:

Training Schedule: First 3 days on assignment: 8:30-5:00pm (Mon-Weds), then 8:00-4:30pm Monday-Friday for 6-8 weeks.

Once training is completed, Shift Hours: 8:30-5:00pm.

Responsibilities:

• Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.
• Reviews and adjudicates claims and/or non-medical appeals.
• Determines whether to return, deny or pay claims following organizational policies and procedures.
• Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards. Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.

Skills:

• Good verbal and written communication skills. Strong customer service skills.
• Good spelling, punctuation and grammar skills.
• Basic business math proficiency. Ability to handle confidential or sensitive information with discretion.

Education:

• High School Diploma or equivalent
• Required Work Experience: years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work experience.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

AI Statement:

By applying, you acknowledge that AI-assisted tools may be used during hiring.