Healthcare Customer Service Representative - Tallahassee, FL

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:

• One location

Work Remotely:

• Temporarily due to COVID-19