CUSTOMER SERVICE REPRESENTATIVE

Northwood Group; Warren (MI); On-site; USD 40,000 - 50,000; Full time

Job summary

A leading company in health plan benefit administration is seeking a Customer Service Representative to facilitate communication and coordinate pharmacy services. The role demands excellent communication skills, data entry experience, and the ability to work effectively in a diverse environment. As a part of a dynamic team, you will play a crucial role in supporting claimants and healthcare providers.

Qualifications

• High School Graduate or GED required.
• HHA certification or Nursing Assistant preferred.
• Data entry experience required.

Responsibilities

• Answer incoming pharmacy phone calls and input information according to criteria.
• Maintain communication with claimants and other stakeholders.
• Set-up new claimant files and verify eligibility.

Skills

Excellent phone and customer related communication skills

Ability to communicate clearly

Ability to multi-task

Computer and typing skills

Education

High School Graduate, GED

Home Health Aide certification

Nursing Assistant certification

Hospital Unit Clerk certification

Job description

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Job Description

The Customer Service Representative is responsible for performing all tasks relevant to in-house communications with the claimant's referral source, adjuster/examiner, case manager and physician’s office for verification of eligibility or coordination of benefits and services requested. The customer service staff coordinates set-up of pharmacy services.

Job Description

The Customer Service Representative is responsible for performing all tasks relevant to in-house communications with the claimant's referral source, adjuster/examiner, case manager and physician’s office for verification of eligibility or coordination of benefits and services requested. The customer service staff coordinates set-up of pharmacy services.

Qualifications:

• High School Graduate, GED
• Home Health Aide (HHA) certification, Nursing Assistant certification, or Hospital Unit Clerk preferred, not required
• Data entry experience
• Excellent phone and customer related communication skills
• Ability to communicate clearly, both verbally and in writing
• Ability to multi-task to meet established deadlines
• Ability to prioritize work flow
• To work effectively with a wide range of people including referral sources, claimants, clients, physician offices, case managers, co-workers and management
• Computer and typing skills
• Adaptable to varied work environments with or without reasonable accommodation
  
  

Principal Duties and Responsibilities:

• Answer incoming pharmacy phone calls and input information according to auto no-fault/PIP/Workers’ Compensation criteria and diagnosis
• Maintain open line of communication with claimants, care givers, case managers, adjusters/examiners, physician’s offices, hospitals and referral source,
• Respond to claimants’ questions and concerns.
• Set-up of new claimant files, verifying eligibility information for full or coordination of benefits
• Letter of Medical Necessity requests for physician involvement in ordering supplies or medications
• Verify claimants address and telephone number for each delivery
• Review order for completeness and accuracy before faxing order to Northwood provider for set-up
• Surveys for new and current claimants
• After hours on-call responsibilities
• Other related duties assigned by the Program Manager/Assistant Program Manager
  
  

Company Description

Northwood plays an integral role in health plan benefit administration for durable medical equipment, prosthetics, orthotics and medical supplies.

Northwood also serves auto and workers compensation clients and their PIP claimants.

Northwood plays an integral role in health plan benefit administration for durable medical equipment, prosthetics, orthotics and medical supplies. Northwood also serves auto and workers compensation clients and their PIP claimants.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Software Development

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