Remote Claims Resolution Specialist

Geisinger; United States; Remote; USD 32,000 - 42,000; Full time

Benefits offered by this job

Healthcare benefits from day one

Vision

Dental

Domestic partners

Job summary

Geisinger is seeking a Customer Service professional to assist in resolving customer concerns, provide education, and maintain high levels of satisfaction. You will participate in cross training and help improve processes within the Customer Service team.

Responsibilities include determining coverage of services, reviewing suspended claims, guiding peers on policies, and supporting staff with claims issues and payment reconsideration.

Qualifications

• High School Diploma or GED is required.
• Minimum of 1 year of Customer Service experience.
• Strong communication skills and customer service mindset.

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 in order to assist members and providers.
• 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 is seeking a Customer Service professional to assist in resolving customer concerns, provide education, and maintain high levels of satisfaction. You will participate in cross training and help improve processes within the Customer Service team.

Responsibilities include determining coverage of services, reviewing suspended claims, guiding peers on policies, and supporting staff with claims issues and payment reconsideration.