Customer Service Representative - Coastal TPA
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
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.
- 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.
- 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
Job Status: Full Time
Job Reference #: 2022-1158