Healthcare Customer Service Rep - (Louisiana)

Job Description:

Join our team as a Healthcare Customer Service Rep II, where you will play a crucial role in taking member services calls in relation to policy management, benefits and claim inquiries. You will be a valued member of the team, providing exceptional customer service to our clients and members by ensuring their satisfaction on calls. As a key contributor, you will be responsible for accurately and efficiently reading and relaying information to members.

This position requires a solid understanding of the healthcare medical claims, benefits and policy process flows and expertise in healthcare terminology, including ICD-9 and ICD-10 coding.

Job Type: Full-time - 100% Remote Position

Schedule: Monday -Friday 9:00am to 9:00pm EST/8:00am to 8:00pm CT (shifting schedule)

You will be responsible for:

Policy Management

• Billing: Process member payments, address billing inquiries, and resolve billing discrepancies.
• Member Information Updates: Update member information accurately and promptly, including addresses, phone numbers, beneficiaries, and employment details.
• Policy Terminations and Reinstatements: Handle policy termination requests, process policy terminations effectively, and assist with policy reinstatements.
• ID Card Ordering: Process ID card orders efficiently, ensure timely delivery, and address any ID card-related concerns.

Benefits

• Coverage Information: Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions.
• Prior Authorization and Referrals: Assist members with prior authorization and referral processes, guiding them through the procedures and requirements.
• Healthcare Provider Contact Research: Conduct thorough research to locate contact information for healthcare providers, ensuring accurate and up-to-date information for members.

Claims

• Claims Status Updates: Provide accurate and timely status updates on claims, explaining the processing stages and addressing any concerns.
• Claims Inquiries: Answer questions about claim processing, explaining claim denials, and providing guidance on submitting appeals.
• Claims Reconsideration Requests: Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.

General Inquiry

• Website Troubleshooting: Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems.
• General Questions: Answer general questions about health insurance plans, providing comprehensive and accurate information on various topics.

Additional Responsibilities

• Maintain Confidentiality: Adhere strictly to confidentiality policies and safeguard sensitive member information.
• Escalate Complex Issues: Escalate complex issues to supervisors or managers for further assistance and resolution.
• Continuous Learning: Stay updated on changes in health insurance regulations, policies, and procedures.
• Contribute to Team Success: Collaborate effectively with team members to achieve shared goals and maintain a positive work environment.

Preferred Experience:

• Strong computer experience (data entry, screen navigation, keyboarding),
• Excellent customer service skills
• Ability to adhere to daily schedules and duties.
• Excellent oral and written communication skills
• In-depth knowledge (Healthcare terminologies, Eligibility, Benefits, Medical Claims, ICD-9 and ICD-10 coding, Policy Process flow) is required
• Multi-task along with attention to detail
• Self-motivation, organized, time-management and deductive problem-solving skills
• Work independently and as part of a team

Requirements:

• High School Diploma or General Education Degree (GED) required
• At least two (2) years of experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field
• Must be able to clear a criminal background check

***WORK FROM HOME REQUIREMENTS***

• High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide a speed test.
• Ability to directly hardwire to your modem
• Required to have a quiet dedicated work area.

What We Offer:

• Paid training period
• Medical, Dental, Life, Vision, HSA, 401K
• PTO
• Equipment provided