Job Summary
The Service Center Representative processes medical claims and communicates with providers about the claims process. This position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The representative expedites the claims process, provides detailed claim notes on all calls, resolves issues, and directs calls to an appropriate escalation path as needed.
Essential Functions, Duties, and Responsibilities
- Act as the primary liaison with callers, following client specifications to assist with questions and solve problems related to the claims process.
- Educate and inform customers via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status.
- Educate members and providers on client requirements and benefit plans, documenting all required details of the call in a concise, professional manner.
- Enter verbal and written application information accurately into the claims management system.
- Assign new claims to the appropriate claims handler.
- Direct customer calls to the appropriate contact at multiple locations or escalate to management as needed.
- Attendance during scheduled work hours is required.
- Perform other duties as assigned and support the organization's quality programs.
Job Specifications
Requirements:
- Claims and customer service experience is a priority; must be a US Citizen.
- All candidates must be able to work a set shift: 11:30 AM to 8:00 PM EST. There may be earlier shifts.
- Duration: 90 days, with the option for extension.
- Location: Remote.
- Minimum IT Requirement: Ensure candidates meet the work-from-home IT requirements.
- Understanding of how offices operate is beneficial but not essential.
- Spanish speaking is a plus but not mandatory.
Education:
- High School diploma or GED required. College courses preferred.
Experience:
- One (1) year of customer service and claims experience or an equivalent combination of education and experience is required.
- Inbound call center experience preferred.
Other Skills and Abilities, Qualifications:
- Knowledge of medical terminology.
- Understanding of claims management.
- Excellent oral and written communication skills.
- PC literate, including Microsoft Office products, and comfortable on camera when requested.
- Analytical and interpretive skills.
- Strong organizational skills.
- Good interpersonal skills.
- Ability to multitask in a fast-paced environment.
- Ability to support multiple clients across communication channels and utilize multiple systems simultaneously.
- Ability to work in a team environment and/or independently.
- Ability to meet or exceed performance competencies.
Note: Credit security clearance, confirmed via a background credit check, is required for this position.
Work Environment
The work environment characteristics are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Persons holding office positions are generally subject to environmental conditions having the lighting, temperature, and noise of an open-floorplan office environment.
Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.