Claims/Customer Service Rep

The Health Plan (THP); Charleston (WV); On-site; USD 35,000 - 45,000; Full time

Job summary

The Health Plan (THP) in Charleston, West Virginia, seeks a CDS Representative responsible for processing payment requests for Consumer Driven Product lines while managing customer inquiries professionally. The ideal candidate should possess a high school diploma and demonstrate strong problem-solving, Microsoft Office proficiency, and attention to detail.

This full-time position offers a schedule of 8:00am – 5:00pm, requiring adaptability to changes and a positive attitude.

Qualifications

• Motivated and able to work independently.
• Proficient in Microsoft Office products.
• Detail-oriented with good problem-solving skills.

Responsibilities

• Process payment requests for Consumer Driven Product lines.
• Answer customer telephone calls professionally.
• Manage claims and/or calls workload effectively.

Skills

Problem solving skills

Attention to detail

Basic math skills

Proficiency in Microsoft Office

Independently motivated

Ability to prioritize

Education

High School graduate or equivalent

Job description

The CDS Rep is responsible for all aspects of processing payment requests for all Consumer Driven Product lines as well as answering customer telephone calls and inquiries in a prompt and professional manner.

Required

• High School graduate or equivalent.
• Motivated and works independently.
• Detail oriented with good problem solving skills.
• Ability to prioritize and meet deadlines.
• Proficient in basic math skills.
• Proficient in Microsoft Office products.
• Adaptable to changes.

Desired

• Two (2) years experience in a call center environment.
• Familiar with insurance terminology.
• Knowledge of FSAs, HRAs and/or HSAs.

Requirements

• Claims and/or calls workload management.
• Proficient use of necessary applications to perform various job functions.
• Establish adequate proficiency in claims and customer service processing systems.
• Meet requirements on annual performance evaluation.
• Consistently displays a positive attitude and acceptable attendance.
• Document calls according to departmental guidelines.
• Strategic in call de-escalation.
• Perform additional assigned tasks and complete them in a timely manner.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Work Schedule

Hours: 8:00am – 5:00pm (40 hours per week).