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    Call Center and Claims Representative - Boise, United States - Idaho State Job Bank

    Idaho State Job Bank
    Idaho State Job Bank Boise, United States

    2 weeks ago

    Idaho State Job Bank background
    Description


    Call Center and Claims Representative at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first Humana/iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, claims, and perform other duties as assigned.

    The Call Center and Claims Representative works in a call center setting and provides program, benefit, eligibility, and claims information and describes Humana/iCare services to existing, potential and new members via telephone and in writing.

    This role will also provide responses to provider claim inquiries within the designated timeframes, including claims status, denials, reconsiderations, and explanation of payments.

    Essential Duties and Responsibilities + Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer (member or provider) requests and questions are handled appropriately and in a timely manner.

    + Provides support, guidance, direction & limited education to providers on member eligibility, authorizations, Humana/iCare guidelines and provider portal. + Provides limited authorization information of referrals to providers and members. + Researches issues and uses judgment for obtaining relevant information. + Documents member information, including demographics and contacts made with customers within the Trizetto Call Tracking system. + Consistently meets individual performance and quality goals. + Adheres to Company policy guidelines. + Actively participates in department/company meetings. + Manages complaints/grievances/appeals and route appropriately for research and resolution.

    Use your skills to make an impact Required Qualifications + One (1) year of demonstrated customer service experience in a call center setting with knowledge of appropriate telephone etiquette.

    + One (1) year of experience in health insurance. + Experience in the use of a personal computer and Microsoft Office Products. + Experience communicating with other departments effectively through either verbal or written communications. Preferred Qualifications + Previous experience in Medicaid and/or Medicare customer service and/or claims processing. + Bi-lingual English/Spanish. + Ability to type at least 40 WPM. + Experience working in a managed health care setting.


    Additional Information + Workstyle:
    Home. Home workstyle is de To view full details and how to apply, please login or create a Job Seeker account
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