Healthcare Customer Service Representative - Tallahassee, FL
Essential Job Functions
- Answers telephones and responds to basic customer questions and/or forwards call to appropriate personnel.
- Provides consultancy utilizing knowledge and expertise on insurance and healthcare.
- Develops and implements general insurance and health care policies in accordance with state and federal laws.
- Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.
- Responds to provider appeals and meets with providers to resolve problems/issues.
- Provides directions for utilization review.
- Records call on account history record with results of the inquiry; initiates required confirmation without direct supervision. Researches customer inquiries and responds to appropriate parties in a timely manner.
- Processes customer requests by sending emails, or using other related communication.
- Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls, processes requests and updates account history with results of inquiry to include proper documentation.
- Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues relate to insurance and healthcare programs.
- Interfaces with team members, management, and customers in reference to customer service issues.
- Reviews and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions
Job Type: Full-time
Pay: From $1.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Ability to commute/relocate:
- Tallahassee, FL 32301: Reliably commute or planning to relocate before starting work (Required)
Education:
- High school or equivalent (Required)
Work Location:
Work Remotely:
- Temporarily due to COVID-19