Customer Service Representative - Coastal TPA - Montage Health : Job Details

Welcome to Montage Health's application process!Job Description:The Customer Service Representative is responsible for answering telephone inquiries and responding to correspondence from employer clients, members and providers regarding eligibility, claims status and benefit determinations.Responsibilities

• Intake all customer (provider, member and health plan) calls as they relate to inquiries and grievances.
• Explain health insurance benefits, policies and procedures to members and providers, i.e., claims submission, appeal process, medical review, documenting all communication.
• Investigate timely filing of provider claims.
• Serve as a point of contact and liaison for customers.
• Successfully implement dispute resolution.
• Provide proactive and event-related education to customers.
• Facilitate customer care as appropriate.
• Assure accurate and timely response to all customer inquiries.
• Log calls and document action plans.
• Successfully bring all issues to closure within appropriate timeframe.
• Proactively identify areas of improvement and provide feedback.
• Perform member and provider satisfaction surveys as appropriate.
• Provide support and coverage to interdepartmental staff as needed.
• Coordinate customer grievances with appropriate department.
• Develop strong partner relationship with customers.
• Perform other activities and functions as defined by the Claims Manager.

Position Requirements

• Minimum A.A. degree or equivalent practical experience in related or similar positions.
• At least two years' experience in customer service/call center within the managed care, insurance, healthcare, or related call center environment
• Strong comprehension skills
• Ability to communicate effectively, including written and verbal communication skills
• High level of attention to details in obtaining complete and accurate information
• Problem resolution skills
• Strong interpersonal and negotiation skills
• Ability to key data accurately and rapidly
• Basic knowledge of insurance terminology and medical coding, e.g. ICD and CPT
• Ability to operate computer equipment and software programs necessary to fulfill position responsibilities
• Working knowledge of Microsoft office products including Outlook, Word, and Excel
• Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff.
• Excellent phone manner and ability to handle multiple phone lines.
• Must be able to meet established deadlines

Pay rate: $23.00 an hourEqual opportunity employer.Assigned Work Hours:8:00am - 4:30 pmPosition Type:Regular