Customer Service Representative I - Claims, Geisinger Health Plan (Pennsylvania resident)

Location: Work from home (Pennsylvania) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: No Job Summary: Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service in only one of the Primary Functions. Actively participates in cross training, improving processes within the Customer Service team. Job Duties: Determines if services received are covered benefits as applicable by line of business and product design. Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products. Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers. Provides daily support and advice to member and provider services staff regarding claims issues. Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Position Details: Education: High School Diploma or Equivalent (GED)- (Required) Experience: Minimum of 1 year-Customer Service (Required) Certification(s) and License(s): Skills: Communication, Customer Retentions, Customer Service OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Geisinger is committed to making better health easier for the more than 1 million people it serves. Founded more than 100 years ago by Abigail Geisinger, the system now includes nine hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,600 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and benefits for domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit or connect with us on Facebook, Instagram, LinkedIn and Twitter. * Does not qualify for J-1 waiver. We are an affirmative action, equal opportunity Employer. Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status. #J-18808-Ljbffr Geisinger