[Remote/WFM] Claims Inquiry Unit Representative

Your next great career move starts here. We're looking for a Claims Inquiry Unit Representative! The role is situated in Remote, offering a fantastic work environment. This position requires a strong and diverse skillset in relevant areas to drive success. The salary for this position is set at a competitive salary.

 

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Summary: To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties. Duties and Responsibilities: Be proficient in discussion and execution including, but not limited to, the following: · Multi-Task in a very busy Call Center Environment · Explanation of how the plan works and how to utilize the service · Explanation of the Claim process, payment, denials, etc.. · Explanation/Assist with Benefit clarification, eligibility, verification, and claim status · Participate as a team player by demonstrating support to peers, management, and the department's goals · Attend meetings and training sessions as scheduled · Assist with training new employees as needed · Show flexibility in meeting performance objectives consistent with IPA and department objectives · Document all Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution. · Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal. Minimum Job Requirements: · High school diploma. · Two years of Customer Service/Telemarketing sales or related experience. · Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10 Skills and Abilities: · Must be computer literate, typing 30 wpm · Excellent telephone techniques · Excellent interpersonal and communication skills; strong writing skills · Medical Front and Back Office as well as Claims/Billing experience preferred · Bilingual in Spanish preferred Apply Job!

 

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