Customer Service Representative (Medical)
🇺🇸 USA Only
One80 Intermediaries is a privately held insurance wholesale broker and program manager with offices in both the US and Canada. We offer market leading wholesale access to all major insurance markets in the US, UK, and Canada, as well as in-house binding authority for property & casualty, financial lines, personal lines, life insurance, medical stop loss risks, travel/accident and health, and warranty coverage.
As a subsidiary of Risk Strategies Company, One80 Intermediaries offers a fast-paced and growth-oriented environment for entrepreneurial individuals looking to operate on the cutting-edge of the E&S marketplace.
As a Customer Service Representative, you interact with customers to provide information in response to inquiries about claims. This is a front-line position in our medical department and is crucial in setting the tone for fulfilling our promise of providing exceptional white-glove service to our claimants and callers. You will use your independent judgment and communication skills to obtain information and relay information to claimants and providers.
Primary Responsibilities and Duties:
- Answers incoming telephone calls. Required to login into phone queues (as assigned) daily.
- Provides eligibility and claim information to medical providers and members.
- Reviews and interprets plan certificates to determine covered benefits and limitations/exclusions.
- Investigates claims payment issues.
- Research PPO websites/database as required to determine if claims are received and processed by the PPO network.
- Documents telephone call reason and details in claims system using call tracks.
- Review inventory tool for status requests from providers/members and respond professionally.
- Initiates check inquires (check tracers) from providers and members to determines if claims payment was received.
- Understands HIPAA Regulations and Requirements as it relates to Personal Health information.
- Educates medical providers and members on new technology available to access plan information.
- Uses probing skills to identify customer questions/concerns regarding plan coverage/benefits and provide single call resolution.
- Maintain minimum call standards in accordance with CBP policy, industry standard & other applicable TPA or SLA agreements.
- Completes special projects as required or requested by management.
- High school diploma or GED
- Excellent interpersonal, oral, and written communication skills
- Team-player characteristics
- Strong computer skills
- Problem/issue resolution capability
- Ability to handle multiple tasks, strong organizational/follow-up skills required
- Ability to work effectively in a fast paced, team-based environment
- Effective time management skills