Claims Customer Service Specialist

  • location: Tampa, FL
  • type: Contract
  • salary: $24.19 per hour
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job description

Claims Customer Service Specialist

job summary:
JOB SUMMARY

Responds to member and provider inquiries (phone written or walk in) regarding all aspects of Company business including claims in a professional timely accurate and caring manner while consistently meeting all guidelines

ESSENTIAL FUNCTIONS Note: The following is not intended to be an exhaustive list of all duties required of this position

Key Duties and Responsibilities

  • Responds to member provider and other inquiries via telephone correspondence or lobby walk-in while meeting all corporate guidelines and performance standards
  • Demonstrates appropriate customer-care skills such as empathy active listening courtesy politeness helpfulness and other skills as identified
  • Records investigates and resolves member complaints as detailed in the Grievance Procedure narrative
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures
  • Track grievance case by line of business for compliance and review
  • Assist in resolving member and provider complaints
  • Makes decisions that are consistent with the concept of a win-win-win for members associates and Company
  • Demonstrates based behaviors such as initiative accountability and value
  • Performs skills necessary to create a high-quality customer experience as reflected through acceptable quality audit score and productivity
  • Peforms other duties as assigned
Additional Position Responsibilities Optional MINIMUM QUALIFICATIONS Education State the minimum required for the job Education Level Education Details Required/Preferred

  • A High School or GED Required
  • An Associate's Degree in a related field Preferredor equivalent work experience
Work Experience State the minimum required for the job Experience Level Experience Details Required/Preferred

  • 1+ year of experience in a call center or customer service environment Required
  • 1+ year of experience in grievance experience Preferred
  • Other Experience within a health care company Preferred
Licenses and Certifications List professional licenses and certifications associated with this job Licenses/Certifications Other Licenses/Certifications Required/Preferred

  • Other Customer service quality or training certifications Preferred Skills State the minimum required for the job Skill Sets Other Skills Proficiency
  • Demonstrated written communication skills Intermediate
  • Demonstrated interpersonal/verbal communication skills Intermediate
  • Ability to multi-task Ability to multi-task good organizational and time management skills Intermediate
  • Demonstrated organizational skills Intermediate
  • Ability to effectively present information and respond to questions from families members and providers Intermediate
  • Ability to identify basic problems and procedural irregularities collect data establish facts and draw valid conclusions Intermediate
  • Other Ability to act on feedback provided by showing ownership of his or her own development Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Ability to work as part of a team Intermediate
  • Other Ability to read analyzes and interprets verbal and written instructions Intermediate
  • Other Seeks to build trust respect and credibility with all partners through full honest consistent and coordinated communication Intermediate
Technology List technical skills associated with the job Technology Other Technology Proficiency Required/Preferred

Microsoft Outlook Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts Beginner RequiredMicrosoft Excel Beginner RequiredMicrosoft Word Beginner RequiredHealthcare Management Systems (Generic) Beginner Required

Languages List all that apply Languages Other Languages Required/Preferred

 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: High School
experience: 1 Years
 
responsibilities:
JOB SUMMARY

Responds to member and provider inquiries (phone written or walk in) regarding all aspects of Company business including claims in a professional timely accurate and caring manner while consistently meeting all guidelines

ESSENTIAL FUNCTIONS Note: The following is not intended to be an exhaustive list of all duties required of this position

Key Duties and Responsibilities

  • Responds to member provider and other inquiries via telephone correspondence or lobby walk-in while meeting all corporate guidelines and performance standards
  • Demonstrates appropriate customer-care skills such as empathy active listening courtesy politeness helpfulness and other skills as identified
  • Records investigates and resolves member complaints as detailed in the Grievance Procedure narrative
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures
  • Track grievance case by line of business for compliance and review
  • Assist in resolving member and provider complaints
  • Makes decisions that are consistent with the concept of a win-win-win for members associates and Company
  • Demonstrates based behaviors such as initiative accountability and value
  • Performs skills necessary to create a high-quality customer experience as reflected through acceptable quality audit score and productivity
  • Peforms other duties as assigned
Additional Position Responsibilities Optional MINIMUM QUALIFICATIONS Education State the minimum required for the job Education Level Education Details Required/Preferred

  • A High School or GED Required
  • An Associate's Degree in a related field Preferredor equivalent work experience
 
qualifications:
Work Experience State the minimum required for the job Experience Level Experience Details Required/Preferred

  • 1+ year of experience in a call center or customer service environment Required
  • 1+ year of experience in grievance experience Preferred
  • Other Experience within a health care company Preferred
Licenses and Certifications List professional licenses and certifications associated with this job Licenses/Certifications Other Licenses/Certifications Required/Preferred

  • Other Customer service quality or training certifications Preferred Skills State the minimum required for the job Skill Sets Other Skills Proficiency
  • Demonstrated written communication skills Intermediate
  • Demonstrated interpersonal/verbal communication skills Intermediate
  • Ability to multi-task Ability to multi-task good organizational and time management skills Intermediate
  • Demonstrated organizational skills Intermediate
  • Ability to effectively present information and respond to questions from families members and providers Intermediate
  • Ability to identify basic problems and procedural irregularities collect data establish facts and draw valid conclusions Intermediate
  • Other Ability to act on feedback provided by showing ownership of his or her own development Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Ability to work as part of a team Intermediate
  • Other Ability to read analyzes and interprets verbal and written instructions Intermediate
  • Other Seeks to build trust respect and credibility with all partners through full honest consistent and coordinated communication Intermediate
Technology List technical skills associated with the job Technology Other Technology Proficiency Required/Preferred

Microsoft Outlook Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts Beginner RequiredMicrosoft Excel Beginner RequiredMicrosoft Word Beginner RequiredHealthcare Management Systems (Generic) Beginner Required

Languages List all that apply Languages Other Languages Required/Preferred

 
skills: Other
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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