Customer Service Rep - (Medical Claims)

Description: Job Summary The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative expedites the claims process and provides detailed claim notes on all calls; as well as resolves issues and directs calls to an appropriate escalation path as needed.

Job Description

Essential Functions Duties and Responsibilities Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims process and servicing processes. Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status. Educates members and providers on client requirements and benefit plans documenting all required details of the call in a concise professional manner. Enters verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system. Assigns new claims to the appropriate claims handler. Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. Attendance during scheduled work hours is required. Performs other duties as assigned. Supports the organization's quality program(s). Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Requirements: Claims and Customer service is priority for experience, must be US Citizen ALL CANDIDATES MUST BE ABLE TO WORK A SET SHIFT: 8:00am - 4:30pm 8:30am - 5:00pm 11:30am - 8:00pm Duration 90 day, with the option for extension Location - Remote, MCA Minimum IT Requirement = Supplier partners MUST confirm that candidates meet the work from home IT 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. Apply Job!