Claims Support - Customer Service Representative I

Community Care, Inc.; Waukesha (WI); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a Claims Support - Customer Service Representative I to join their dedicated team. This full-time role offers a rewarding opportunity to assist elderly individuals and adults with disabilities in navigating their healthcare needs. You will resolve inquiries, provide education on claims processes, and ensure high-quality service delivery. If you have a passion for helping others and possess a strong customer service background, this position will allow you to make a meaningful impact in the community while enjoying a supportive work environment with excellent benefits.

Benefits

Generous paid time off

Competitive pay and benefits

Flexible benefits plan

Employee referral program

Retirement plan with employer contribution

Employee Assistance Program

Qualifications

• 2+ years of customer service experience in healthcare or insurance.
• Strong knowledge of billing standards and medical terminology.

Responsibilities

• Resolve inquiries regarding member eligibility and benefits.
• Provide technical support on Community Care’s Claim Submission Portal.
• Perform claim adjustments and document inquiries accurately.

Skills

Customer Service

Problem Solving

Communication Skills

Knowledge of Medicare and Medicaid

Multitasking

Education

High School Diploma

Medical Coding Certification

Associate's Degree

Job description

Claims Support - Customer Service Representative I

Dolphin Drive - Waukesha County, 1801 Dolphin Drive, Waukesha, Wisconsin, United States of America Req #2894

Monday, April 21, 2025

Claims Support - Customer Service Representative I, Full-Time, 1st Shift

Community Care is hiring a Claims Support - Customer Service Representative I. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This is a full-time opportunity at our Waukesha site.

Claims Support - Customer Service Representative I Job Responsibilities:

• Resolves incoming telephone, email, and chat inquiries from providers regarding member eligibility and benefits, authorization requirements, claim status, and claim payment.
• Utilizes knowledge of Medicare and Medicaid programs, institutional and professional billing standards, ICD-10, CPT and HCPCS, revenue codes and medical terminology to identify and address billing issues.
• Provides education, technical support, and guidance to providers on use of Community Care’s Claim Submission Portal (CSP) and other Community Care provider systems.
• Multitasks and uses multiple systems and programs during calls to assist the provider.
• Researches, resolves, and documents claims-related inquiries and informal grievances from external and internal parties within the established timeframes in an accurate and professional manner.
• Ensures first call resolution by asking probing questions to identify root cause of issues.
• Utilizes soft skills to effectively deescalate provider issues. Utilizes appropriate systems and resources to respond to provider inquiries.
• Performs simple claim adjustments needed to resolve inquiries.
• Identifies trends and issues and escalates to leadership when appropriate.
• Assists in the development and communication of resolutions to all partners as needed.
• Performs in accordance with Claims department’s performance and quality goals.

Job Requirements:

• Education: Required - High School Diploma
  Preferred - Medical coding certification or Associate’s degree or higher in a relevant area of study
• Experience: Required - Two years customer service experience in a healthcare or insurance-related industry
  Preferred - Experience with health insurance, Medicare/Medicaid, medical claims processing, and/or medical coding

Claims Support - Customer Service Representative I Job Schedule:

• 8:00AM - 4:30PM, 40 hours per week
• Monday - Friday

About Community Care

Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs. Together with our community partners, we’re committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.

Compensation and Benefits:

Our employees make a real difference in people’s lives every day, that is why we are proud to offer a compensation package that includes:

• Generous, paid time off
• Competitive pay and benefits (health, dental, vision, etc.)
• Flexible benefits plan
• Employee referral program
• Retirement plan with employer contribution
• Employee Assistance Program

Community Care is an Equal Opportunity Employer