Claims Customer Service Representative - Vista, United States - Physicians Data Trust

Physicians Data Trust

Verified Company

Vista, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Claims Customer Service Representative

Department:

Claims

Effective Date:

January 12, 2022

Reports to:

Claims Support Supervisor

Direct Reports:

None

FLSA:

Non-Exempt

Working Conditions:
Normal, no adverse or hazardous conditions.

Primary Purpose:

To provide high-level customer service to PDTs' clients following accuracy.

Principal Duties and Responsibilities ( = essential functions):
Answer calls from members, providers, and health plans regarding specific claim
issues. Route and redirect calls as necessary.

Perform timely follow-up on calls requiring research and call back.

Accurately interpret DOFRs
Division of Financial Responsibility documents that

- determine who pays for specific health care services (PDT, health plan, or other).

Use MedMC software to log incoming calls and the resolution of the call.

Act as a backup resource to cover front desk phones/greet walk-in guests, data entry
of paper claims, and open/sort/batch incoming claims mail.

Complete other tasks as assigned.

Job Specifications (KSAs):

Requires the ability to speak, read, write, and understand English and other
general educational skills as is generally obtained by completing high school or a
GED.

Knowledge of the health or managed care industry is generally obtained through 1-2
years of work experience.

Position Performance Criteria:

Consistently produces accurate and timely work product as it relates to departmental
goals.

Demonstrates high reliability through consistent punctuality and attendance.

Competently performs position requirements with mínimal supervision and direction,
including taking initiative and assuming responsibility for follow-through.

Demonstrates excellent interpersonal skills as discerned through observation and team
project successes.

Accurately interprets and applies departmental policies and procedures using sound
judgment.