Employer Service Rep - The Health Plan : Job Details

The Employer Service Representative is responsible for answering telephone calls from client contacts in a prompt and courteous manner, resolving any client issues relating to claims and eligibility, and to responding to written inquiries from clients. The ESR is responsible for keeping the account executive and management informed of any trends or issues identified.

The ESR will also be responsible for reviewing No Surprise Act (NSA) requests and responding in a timely manner. NSA responsibilities include, but are not limited to, negotiating on behalf of clients within given guidelines and keeping the client, account executive and management up to date on case progress, preparing reporting for executive management and reporting any trends or issues identified.

Required:

* High School graduate or equivalent.

* Self-starter and works independently.

* Detail oriented with good problem solving skills.

* Ability to prioritize and meet deadlines.

* Maintains confidentiality.

* Good communication skills.

* Proficient in Microsoft Office products (Word, Excel, Power Point).

* Easily adapts to changes in work requirements.

Desired:

* Bachelor's degree from an accredited college or university.

* Previous experience in working with health insurance.

* Medical Terminology.

* Knowledge of CPT and ICD-9/ICD-10 coding .

* Knowledge of medical and hospital claims.

Responsibilities:

* Answer all calls and correspondence in a timely, professional and friendly manner.

* Resolves client issues.

* Works with operations team to have claims processed or adjusted as needed.

* Communicates with clients, members and providers as necessary to obtain information necessary to resolve issues.

* Records and tracks all information clearly and accurately.

* Understands benefits and copay detail in order to relay this information clearly and accurately.

* Understands claim detail, identifies claims issues and reports issues to the Manager when necessary.

* Keep all member protected health information (PHI) confidential.