Enrollment & Claims Support Specialist

Geisinger; Danville (PA); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Healthcare benefits

Vision & dental coverage

Domestic partner benefits

Job summary

Geisinger in Danville, PA is seeking a Customer Service Representative to assist in resolving member concerns, explain benefits, and maintain high satisfaction. You will participate in cross training and help improve processes within the Customer Service team.

Responsibilities include handling enrollment and eligibility issues, communicating with health plan members and employer groups, applying policy rules, generating enrollment communications, and supporting claims resolution with frontline

Qualifications

• High School Diploma or GED required.
• Minimum 1 year of customer service experience required.

Responsibilities

• Resolves enrollment reports and eligibility issues following policy and state guidelines.
• Initiates communication and literature to newly enrolled health plan members, dependents and employer groups.
• Interprets and applies rules in contractual agreements with employer groups and vendors.
• Performs membership data extract reports for audit purposes.
• Updates membership data and workflow in employer group modules.
• Determines eligibility and handles terminations and disenrollments.
• Prepares and disseminates enrollment communications to subscribers/members.
• Determines if services received are covered benefits by product design.
• Reviews suspended claims applying current policies and benefits.
• Provides guidance to peers on claims resolution policies.
• Researches claim issues and identifies criteria for reconsideration for payment.

Skills

Customer service

Education

High School Diploma or GED

Job description

Geisinger in Danville, PA is seeking a Customer Service Representative to assist in resolving member concerns, explain benefits, and maintain high satisfaction. You will participate in cross training and help improve processes within the Customer Service team.

Responsibilities include handling enrollment and eligibility issues, communicating with health plan members and employer groups, applying policy rules, generating enrollment communications, and supporting claims resolution with frontline