Claims & Customer Service Rep (Medical Benefits)

Medical Claims and Customer Service PositionMostly RemoteThis is a Hybrid position, and it will be rare that you have to work onsite. Most of it is remote work, but you still have to live in the Los Angeles CA area to be considered.This role is customer-facing and is considered a key customer service representative for the Health Organization. The Medical Claims Specialist/Analyst will process health insurance claims and answers calls from the customer (participant members, providers, physicians, hospitals etc.) Adhere to eligibility, claims and call policies and procedures while making sound claim/call decisions.

Create relationships through the resolution of customer incoming call requests. Serve our customers by determining requirements, answering inquiries, resolving problems, and fulfilling requests.Responsibilities:Answer incoming phone calls from customers and identify the type of assistance the customer needs (e.g. benefit and eligibility, billing and payment inquiries, authorizations for treatment and explanation of benefits (EOBs))Communicate and collaborate with customers to resolve issues, using clear, simple language to ensure understandingReview and research incoming healthcare claims by navigating multiple computer systems and platforms and verify the data/information necessary for processing (e.g.

pricing, prior authorizations, and applicable benefits)Ensure that the proper health benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, federal mandates, CMS/Medicare guidelines, and benefit plan documents/certificates)Conducts research and analysis of historical, current and future benefit trends, service improvements and impacts to fundQualifications and Education Requirements:Bachelor's Degree in Healthcare, Math, Engineering or related field requiredMinimum of four (3) years of claims processing preferredMinimum of four (2) years in heavy call center requiredLearn various software applications and become self-sufficient in using the software in a user interface environmentDemonstrate adaptability and forward-thinking in the face of technological or organizational changeProficient with Microsoft products, including Word, Excel and OutlookExcellent customer service and telephone skillsKnowledge of medical terminologyAbility to research and verify claims payment, benefits, and eligibility issuesStrong knowledge of benefits plans, policies and proceduresCompany Benefits:Salary range offered $56,000-$63,000 to startMedical, Dental & Vision Health Insurance is paid 100% by Employer (you can add up to 5 dependents for health coverage, and it costs $50 a month total for dependents coverage).401K with 2% Employer MatchEmployer Pension! – Vested after 5 yearsPTO- 2 weeks – 5 weeks of time off depending on your years with the companyHoliday Pay -2 Floating Holidays & you get your Work Anniversary off every yearSick Pay – 12 days a yearCareer advancement opportunities & the ability to work for a very reputable and longstanding organization.Equal Opportunity Employer