Remote Claims & Member Support Specialist

Geisinger Clinic; United States; Remote; USD 34,000 - 42,000; Full time

Job summary

Geisinger Clinic is seeking a Customer Service Representative to assist in resolving member concerns, provide education and maintain high satisfaction. This role supports claims-related inquiries and cross-training within the Customer Service team.

Work is from home (Pennsylvania) with a 40-hour weekly schedule; typically days shift, regular worker type, and no exemption. High school diploma and 1 year of customer service experience required.

Qualifications

• Requires High School Diploma or GED.
• Minimum 1 year of customer service experience.
• Strong communication and interpersonal skills.

Responsibilities

• Determines if services received are covered benefits as applicable by line of business and product design.
• Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
• Provides team building resources to assist in directing peers to proper claims resolution policies and procedures.
• Provides daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.

Skills

Communication

Customer Retentions

Customer Service

Education

High School Diploma or GED

Job description

Geisinger Clinic is seeking a Customer Service Representative to assist in resolving member concerns, provide education and maintain high satisfaction. This role supports claims-related inquiries and cross-training within the Customer Service team.

Work is from home (Pennsylvania) with a 40-hour weekly schedule; typically days shift, regular worker type, and no exemption. High school diploma and 1 year of customer service experience required.