Customer Service Representative

Job Summary:

The Customer Service Representative handles incoming calls from plan members and healthcare providers, providing information related to medical, dental, vision, and prescription drug claims based on plan provisions. This role involves documenting calls, processing referrals and pre-certifications, researching claims, and performing other job-related duties as assigned.

Location:Kailua, Hawaii, United States

Responsibilities:

- Handles incoming calls from plan members and healthcare providers.
- Provides information on medical, dental, vision, and prescription drug claims.
- Documents all calls accurately and completely.
- Receives and processes referrals and pre-certification requests from providers.
- Reviews referrals/pre-certifications for proper benefits and eligibility.
- Enters referral and pre-certification data into the computer system.
- Reviews referrals and medical record information to facilitate claims adjudication.
- Researches and documents rejected or erroneous claims for correction.
- Performs other job-related duties as assigned.

Required Skills & Certifications:

- Excellent computer skills.
- Excellent telephone skills.
- Excellent organizational skills.
- High School Education/GED or equivalent.
- 1-2 years of relevant experience.

Preferred Skills & Certifications:

- Not specified.

Special Considerations:

- This is an onsite position.

Scheduling:
- Day shift.
- Monday through Friday.
- 8:30am to 5:00pm.
- 40 hours per week.