Customer Service Representative

QualChoice

(Arkansas 300)
Full Time
Job Posting Details
About QualChoice
QualChoice Health Insurance is your trusted partner in providing the best value in health benefits for your employees or customers — or for you and your family. Our friendly, personal service and track record of treating people right are one reason we’re the quality choice for health insurance in Arkansas.
Summary
The Customer Service Representative is responsible for answering telephone inquiries of accounts, enrollees, and providers on matters pertaining to claims adjudication, enrollment, benefit interpretation, etc., utilize the telephone system equipment and the Health Claims Processing System, PBM systems, in performance of assigned tasks. The representative assumes responsibility for the timely and accurate processing of inquiries in accordance with corporate guidelines pertaining to coverage, payment, quality and productivity.
Responsibilities
* Accurate as well as timely documentation and resolution of inquiries pertaining to all types of medical services, i.e., professional, institutional, pharmacy, durable medical equipment, dental and vision. * Notify callers of resolutions via telephone and in writing when appropriate according to departmental turnaround standards. * Respond to benefit questions for existing and prospective enrollees on all lines of business during open enrollment periods. * Serve as an inter-departmental liaison identifying problems and helping to resolve them. * Perform enrollment and benefit verification. * Provides claims follow-up. * Handles walk-in inquiries as needed. * Maintains quality standards as determined by management. * Adheres to all company policies and federal and state privacy regulations in accordance with company training. * Perform other duties as assigned. * Conducts business with high regard for corporate values and in compliance with its Code of Business Conduct. * Maintains high regard for member privacy and complies with information security and HIPAA policies. * Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company’s quality initiatives. * Accountable for all actions/responsibilities described in the company’s policies and procedures as they relate to this position.
Ideal Candidate
* Excellent written, interpersonal and verbal communication skills. * Sound analytical skills. * Excellent computer keyboard and 10 key calculator skills * Must have a high school diploma or equivalent. * Required two years of Customer Service experience gained through positions held in the health insurance or health care field with exposure to benefits, eligibility and claims processes. * Required knowledge of medical terminology, CPT and ICD coding. * High school diploma or equivalent. * At least two years of customer service experience gained through positions held in the health insurance industry and or medical claims processing. * Applicant must possess excellent grammar and soft skills in communicating over the telephone or in person. * Knowledge of medical terminology, CPT and ICD coding.

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