Membership and Claims Customer Service Representative

summay
Primary Responsibility is to serve 1199 New England Health Care Employees Welfare Fund members with compassion, understanding, and patience. The individual in this role must accurately document and update membership and claims system to reflect the telephonic and/or mail inquiries as appropriate. As the primary point of contact, this role serves as the face of our Fund Office that shapes the members’ perception through exceptional and personalized service.

Duties

• Handle inbound and outbound calls in a timely manner, follow scripts where applicable and provide solutions to members and follow up to resolve any issues and/or complaints.
• Mail Claim & Membership documents requested by members in support of membership and claims management requirements (e.g., Accident Questionnaires, COB forms, enrollments, STD forms).
• Review and identify issues related to claim denials and any gap in eligibility including associated documentation received to determine the next course of action to resolve the issues. If necessary, triage the issue to the senior claims specialist to adjust, as necessary.
• Submitting adjustment request to Health Carrier for denied claims or delegating FIA adjustment request to Sr. Claims Reps
• Process all documentation received by the fund and accurately document the system.
• Assist Claims with documentation and correspondence and keep track of request and receipt of documents
• Assist provider inquiries for copies of Explanation of Benefits (EOBs)
• Handle projects assigned by manager
• Function as a back when assigned by the manager for receptionist duties and other specific projects

To be successful in this role the individual must have empathy, compassion and be adapable to members when they are stuggling to find answers to their issues.

Required

• Minimum High School Diploma
• One year customer service experience preferable
• Working knowledge of health care preferably in claims operations
• Working knowledge of Microsoft suite of products (word, excel)
• Great Team Player
• Excellent communication skills
• Excellent attitude

Preferred:

• One year customer service experience
• Working knowledge of health care, claims operations

Pay: From $22.78 per hour

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Prescription drug insurance
• Retirement plan
• Vision insurance

Work Location: In person