- Multi-Task in a very busy Call Center Environment
- Explanation of how the plan works and how to utilize the service
- Explanation of the Claim process, payment, denials, etc.
- Explanation/Assist with Benefit clarification, eligibility, verification, and claim status
- Participate as a team player by demonstrating support to peers, management, and the department's goals
- Attend meetings and training sessions as scheduled
- Assist with training new employees as needed
- Show flexibility in meeting performance objectives consistent with IPA and department objectives
- Document all Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.
- Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal.
- Must be computer literate, typing 30 wpm
- Excellent telephone techniques
- Excellent interpersonal and communication skills; strong writing skills
- Medical Front and Back Office as well as Claims/Billing experience preferred
- Bilingual in Spanish preferred
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Claims Inquiry Unit Representative - Los Angeles, United States - MedPOINT Management/HCLA
Description
Job Description
Job DescriptionSummary:
To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties.
Duties and Responsibilities:
Be proficient in discussion and execution including, but not limited to, the following:
Minimum Job Requirements:
High school diploma. Two years of Customer Service/Telemarketing sales or related experience. Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10, HFCA1500 Forms, UB94 Claim Forms
Knowledge, Skills and Abilities Required:
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