Claims Service Representative
- Professionally handle incoming inquiries via telephone, email or fax from providers (i.e. physician offices, clinics, social day cares, home care agencies, DME suppliers) regarding claim decision and payments across all Centers Plan for Healthy Living (CPHL) product offerings.
- Thoroughly and efficiently gather claim information, assess and fulfill the caller's needs and educate the caller where applicable regarding claim submission procedures.
- Focus on resolving issues on the first call; navigate through the appropriate computer system(s) to identify the current status of the issue.
- Adjust claim(s) as warranted based on discussion and review of the provider's issue.
- Deliver all information and questions in a positive, conversational and compassionate manner to facilitate developing a relationship with the provider, while providing the best customer service experience possible
- Warm transfer calls to other business units for further resolution of the callers issue while adhering to CPHLs policies.
- Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
- Prepares correspondence, maintains phone and contact logs, and documents call details as appropriate.
- Meet or exceed the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance
- Continuously evaluate and identify opportunities to drive process improvements that positively impact providers.
- Maintains strong knowledge of CPHL products and the applicable state and federal regulations.
- HS Diploma
- 2 years of college preferred
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