Customer Service Rep - Self Funded - Carle Health : Job Details

Overview Responsible for accurately and completely answering and documenting inquiries from members, employers, employer groups and providers. Facilitates communication between self, other departments, members, providers, provider offices, employers, and brokers to ensure that needs of members are met. Responsibilities EDUCATIONAL REQUIREMENTS None specified CERTIFICATION & LICENSURE REQUIREMENTS Medical Terminology within one (1) year of hire EXPERIENCE REQUIREMENTS Three (3) General - Customer Service. Must be proficient in using a computer keyboard, navigating multiple software applications, managing a multi-line phone and completing documentation during the course of a call. SKILLS AND KNOWLEDGE Must be able to project a professional, pleasant image, while interacting with a variety of personalities and cultures. Must demonstrate tact and diplomacy in interpersonal interactions, in addition to maintaining composure in confrontational situations. Essential Functions: Meets standards for documentation, answering and follow-up on all benefit, eligibility, network, and claims inquiries from Health Alliance members and providers generated by telephone, walk-in, or written correspondence. Takes action to resolve customer service, claims, or billing complaints by partnering with other departments if and when necessary. Follows up to ensure that appropriate changes were made to resolve the source of the problem. Refers unresolved complaints to the Customer Service Complaint Resolution Specialist or advises members/providers of the right to appeal. Educates members and providers regarding a variety of insurance topics, including, but not limited to Healthcare Reform, Exchanges, coordination of benefits and Medicare coordination. Processes requests for member materials including, but not limited to ID Cards, federally required Summaries of Benefits and Coverage, Policies, Schedules of Benefits, Provider Directories, Explanations of Benefits, and Remittance Advices. Assists members in accessing company websites. Consistently meets or exceeds department specific performance and quality requirements. Basic communication skills (Telephone Courtesy Guidelines P&P, scripting, and scores/feedback from Quality Assurance Advisor and Customer Service Lead). Basic computer skills (all applications used by Customer Service). Basic problem solving skills. Follows and adheres to accountability structure and required behavioral standards. About Us Find it here. Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all here at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,500 team members in its eight hospitals, physician groups and a variety of healthcare businesses and is recognized as a Great Place to Work. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital and Carle Health Pekin Hospital hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].