HIRING FOR REMOTE HEALTHCARE CUSTOMER SERVICE REPRESENTATIVES

Help improve the health and lives of members in your community by delivering high-quality customer service that is a part of a managed healthcare service. This is your chance to help your community all while in the comfort of your home!

--Must reside in Kentucky to qualify--

Come join one of the leading managed healthcare services as a DIRECT HIRE, full-time employee!

WHY YOU ASK?

• Schedule: Monday through Friday with rotating weekend and rotating holiday. 8 hour shift between 4:45am - 9pm.
• Remote position
• All equipment is provided upon hire
• Full-time, permanent position
• Full benefits upon hire!

The Customer Experience team has several opportunities within our organization. Supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience.

This is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating ethical values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences

JOB DESCRIPTION

Job Summary

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.

Knowledge/Skills/Abilities

• Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
• This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.
• Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
• Assists in the reviews of state or federal complaints related to claims.
• Supports the other team members with several internal departments to determine appropriate resolution of issues.
• Researches tracers, adjustments, and re-submissions of claims.
• Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
• Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
• Handles special projects as assigned.

Knowledgeable in systems utilized:

• QNXT
• Pega
• Verint
• Kronos
• Microsoft Teams
• Video Conferencing
• Others as required by line of business or state

Job Function

Provides customer support and stellar service to assist providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating ethical values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.

Job Qualifications

REQUIRED EDUCATION:

Associate’s Degree or equivalent combination of education and experience;

REQUIRED EXPERIENCE:

2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.

1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry

Pay Range: $16.40 - $31.97 an hour*

ANY INTERESTS OR INQUIRIES PLEASE APPLY HERE

Job Type: Full-time

Pay: $23.36 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift

Experience:

• Healthcare: 1 year (Required)
• Claims Processing: 1 year (Required)
• Call center: 1 year (Required)

Work Location: Remote

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