Inbound Call Center Investigations Specialist - Multiplan : Job Details

Inbound Call Center Investigations Specialist

Multiplan

Job Location : Atlanta,GA, USA

Posted on : 2024-09-18T05:17:17Z

Job Description :

At MultiPlan, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all of our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and upward!!!

Inbound Call Center Investigations Specialist

This position will take a high volume of inbound calls to process a paperless health insurance subrogation caseload by investigating potential cases and pursuing med-pay, no-fault, liability, and workers' compensation recoveries. This position's work environment is team-orientated. The incumbent will coordinate efforts with other members of the subrogation team to maximize recoveries.

JOB ROLES AND RESPONSIBILITIES:

  • Follow client specific procedures and guidelines. Understand basic health plan contractual provisions and apply to the reimbursement efforts. Ensure compliance of state and federal laws.
  • Adapt to process changes and help improve and implement new processes.
  • Identify and develop subrogation opportunities.
  • Research and request case information to develop cases. Access and pull benefits from clients' remote health claim systems.
  • Place parties of interest on notice.
  • Respond timely to all electronic, written and verbal communications. Log information derived from written and verbal communication; where required maintain detailed and accurate records. Maintain a calendar diary to monitor case activity.
  • Pursue worker's compensation, first and third party, med-pay coverage and no-fault recoveries.
  • Engage advice and/or help of Management to proactively resolve cases. Provide feedback to Management and unit on trends or developments.
  • Maintain department productivity and quality standards.
  • Collaborate, coordinate, and communicate across disciplines and departments.
  • Ensure compliance with HIPAA regulations and requirements.
  • Demonstrate Company's Core Competencies and values held within.
  • Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
  • The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

    • JOB SCOPE:

    The incumbent works under general supervision while keeping the needs of external and internal customers as a priority when making decisions and taking action. The incumbent communicates across a base of clients, members, and their employers. The successful individual in this role must be open to feedback, teamwork, and show a keen interest in contributing ideas to improve existing departmental processes. Decision making in the role is limited and must fall within established guidelines and may often end up being escalated to higher levels.

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