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Participant Services -Healthcare Claims

Company: Volt
Location: Burbank
Posted on: March 26, 2020

Job Description:

Excellent Opportunity as a Sr. Participant Services Specialist, processing healthcare insurance claims--(Custom Care). This position is a Direct Hire opportunity offering Health Benefits and a good annual salary based on expertise. This will also give you the opportunity to work for a very reputable company that offers a wonderful work culture and allot of room for advancement and promotions. The responsibilities include processing--health insurance claims and answering--calls from physicians, hospitals and participants for a multi-employer--Fund. Adhere to claim and call policies and procedures while making sound claim/call decisions.Foster strong customer relationships through the resolution of customer incoming call requests. Serve our customers by determining requirements, answering inquiries, resolves problems, fulfilling requests and maintaining key performance measures. Build strong working relationships with others within the company, by demonstrating effective people skills and interpersonal savviness.Senior Participant Service Specialist is expected to be proficient in the standard job functions for this position.PRIMARY RESPONSIBILITIES: Elevate and enhance the Health Funds reputation by providing "World Class Customer Service." Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payment inquiries, authorizations for treatment and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information realtime in computer systems Communicate and collaborate with participants and providers to resolve issues, using clear, simple language to ensure understanding Fulfills requests by clarifying desired-- information; completing call logs by entering required data in realtime; forward requests and follows through on all customer commitments Meet all key performance indicators established for this position in the areas of: --efficiency, accuracy , quality, productivity, system adherence, customer satisfaction and attendance Resolves problems by interpreting and clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; addressing unresolved problems Review and research incoming healthcare claims from participants and medical providers by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits) Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, federal mandates, CMS/Medicare guidelines, benefit plan-- documents/certificates) Trains and coaches new staffSKILLS: Customer Focus, Customer Service, Health Claims Processing, Data Entry Skills, Listening, Phone Skills, Building Relationships, People Skills, Interpersonal Savvy, Problem Solving, Multi-Tasking and Identifies Process Improvements. REQUIREMENTS: 4 years of claim processing and Healthcare Call Center environment experience Strong knowledge of benefits plans, policies and procedures Experience with HMO's & PPO's Healthcare Background in Claims processes preferred Demonstrated organization and time management skills Proficient with Microsoft products, including Word and Excel Proven verbal and written communication skills High school graduate or equivalentThis position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work core 8 hour shift schedules within the Participant Service Team, during our normal business hours of 8:30 to 5:00. It may be necessary, given the business need, to work occasional overtime or weekends. Please apply Today! send your resume to Ida at icarroll@volt.comor call 805-979-3345 Volt is an Equal Opportunity Employer.

Keywords: Volt, Burbank , Participant Services -Healthcare Claims, Healthcare , Burbank, California

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