Customer Service Representative/ Claim Representative
This a Full Remote job, the offer is available from: Anywhere Job Description: Job Tittle: Claim Representative Job Location: 100% Remote Job Type: Full-time Primary Responsibilities:
- Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
- Providing excellent customer service, including the ability to handle escalated callers
- Determining authorization or notification requirements
- Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
- Providing administrative approvals (depends on line of business)
- Handling expedited authorizations, authorization updates and status checks
- Confirming member eligibility
- Outreaches to providers and/or Patient to complete authorization requests and prescriptions
- Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
- Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
- Performs all other related duties as assigned.
- You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required experience:
- Medical Terminology
- ICD 9/ICD 10 and CPT knowledge
- Claim Experience
- Call center experience
- Highschool Diploma minimum is required and will be verified
- 1.5 to 2 years of claims experience
Qualifications:
- High School Diploma / GED (or higher) (This will be verified through $Diverse Lynx$)
- 2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
- Ability to work one of the varying shifts to support our 24hr 7 days a week operation
- Proficiency with Microsoft Office Word (create and maintain documents), Excel (create and maintain spreadsheets) and Outlook (email and calendaring) Medical Terminology
- ICD-9/ICD-10 and CPT Knowledge
- Required to have a dedicated work area established that is HIPPA compliant.
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive approved high-speed internet connection or leverage an existing high-speed internet service
Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company. This offer from "Diverse Lynx" has been enriched by Jobgether.com and got a 82% flex score. Apply Job! Apply to this Job