Job Description

Welcome to Montage Health’s application process!

  • CHOMP has been voted the Best Place to Work in Monterey County for 10 straight years
  • Excellent Pay and Generous Benefits including a Pension and Continuing Education Reimbursement
  • Excellent Team Oriented Culture
  • Free Gym for Employees

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

Aspire Health Plan is an equal opportunity employer.

Assigned Work Hours:

Monday - Friday 8am to 5pm

Position Type:

Regular

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online