Job Description
Are you passionate about helping people navigate the complexities of healthcare? Do you thrive in a fast-paced, remote environment where you can make a real difference? We're seeking a dedicated and knowledgeable Healthcare Customer Service Representative II to join our dynamic team!
In this role, you'll be the voice of our organization, providing exceptional support to members regarding their healthcare policies, benefits, and claims. Your expertise in healthcare terminology, including ICD-9 and ICD-10 coding, will be essential in delivering accurate and efficient service.
What You'll Do:
Policy Management:
Process member payments and resolve billing inquiries.
Accurately update member information, including addresses, beneficiaries, and employment details.
Handle policy terminations and reinstatements with professionalism.
Efficiently process ID card orders.
Benefits:
Provide clear and comprehensive information about coverage plans, eligibility, and limitations.
Guide members through prior authorization and referral processes.
Conduct research to locate healthcare provider contact information.
Claims:
Provide timely claims status updates and address member concerns.
Answer questions about claim processing and explain claim denials.
Assist members with claim reconsideration requests.
General Inquiries:
Troubleshoot website issues and guide members through online navigation.
Answer general questions about health insurance plans.
Additional Responsibilities:
Maintain strict confidentiality of member information.
Escalate complex issues to supervisors for resolution.
Continuously learn and stay updated on healthcare regulations and policies.
Contribute to a positive and collaborative team environment.
What We're Looking For:
Strong computer skills, including data entry and screen navigation.
Excellent customer service and communication skills (both oral and written).
In-depth knowledge of healthcare terminology, eligibility, benefits, medical claims, ICD-9 and ICD-10 coding, and policy process flows.
Ability to multitask, pay attention to detail, and manage time effectively.
Self-motivation and strong problem-solving skills.
Ability to work independently and as part of a team.
Requirements:
High School Diploma or GED required.
2-3 years of experience in claims examination, health insurance, customer service, call center, medical office, or a related healthcare field.
Ability to pass a criminal background check.
Work From Home Requirements:
High-speed internet (25 Mbps download, 5 Mbps upload) with the ability to provide a speed test.
Ability to hardwire directly to your modem.
A quiet, dedicated workspace.
Shifting schedule availability between Monday-Saturday 9:00am to 11:00pm EST/8:00am to 10:00pm CT.
What We Offer:
Paid training.
Comprehensive benefits package, including medical, dental, vision, life insurance, HSA, and 401(k).
Paid time off (PTO).
Provided equipment.
Join our team and make a meaningful impact on the lives of our members!
Employment Type: Full-Time
Salary: $ 17.00 19.00 Per Hour
Job Tags
Hourly pay, Full time, Remote job, Shift work, Saturday,