Claims Service Representative

Diverse Lynx; Michigan; Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company is seeking a Claim Customer Service Representative to manage authorizations and provide top-notch customer service. The role requires excellent coordination skills and the ability to work effectively in a team or independently. Ideal candidates will have a High School Diploma and relevant experience in healthcare or customer service. This full-time position offers a competitive hourly rate and requires a HIPAA-compliant work area.

Benefits

Medical insurance

Vision insurance

401(k)

Qualifications

• 2+ years of experience in healthcare or customer service.
• Proficiency with Microsoft Office tools.

Responsibilities

• Manage authorizations and service requests via phone and faxes.
• Provide excellent customer service and handle escalated calls.
• Prepare authorization cases for Medical Directors.

Skills

Customer Service

Coordination

Authorization

Communication

Education

High School Diploma / GED

Tools

Microsoft Office Word

Excel

Outlook

Job description

This range is provided by Diverse Lynx. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$17.00/hr - $17.00/hr

Job Title: Claim Customer Service Representative

Location: Remote

Duration: Full Time

Job Description:

We’re seeking customer service/claims processors who combine excellent coordination and authorisation skills with the ability to function effectively both as part of a team or on an individual basis to bring their talent to our team.

Primary Responsibilities:

• Managing authorisations / notifications and other service requests received via incoming phone calls, faxes and portal submission
• Providing excellent customer service, including the ability to handle escalated callers
• Determining authorisations or notification requirements
• Preparing authorisations cases for Medical Directors, Network Operations Nurses and Case Managers
• Providing administrative approvals (depends on line of business)
• Handling expedited authorisations , authorisations updates and status checks
• Outreaches to providers and/or Patient to complete authorisations requests and prescriptions
• Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
• Utilising experience and judgement to plan, accomplish goals and effectively resolve each assigned task
• Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
• Performs all other related duties as assigned.

Qualifications:

• High School Diploma / GED (or higher)
• 2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
• Proficiency with Microsoft Office Word (create and maintain documents), Excel (create and maintain spreadsheets) and Outlook(email and calendaring).

Medical Terminology

• ICD-9/ICD-10 and CPT Knowledge
• Required to have a dedicated work area established that is HIPPA compliant.
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive approved high-speed internet connection or leverage an existing high-speed internet service.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Customer Service, Health Care Provider, and Administrative

• Industries

  Hospitals and Health Care, Insurance, and Insurance and Employee Benefit Funds

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

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