Provider Customer Service Representative

Description:
• Answers questions and resolves issues based on phone calls/letters from providers.
• Provide excellent customer services for high volume inbound provider calls.
• Extensive claims research on multiple platforms.
• Uses customer service threshold framework to make financial decisions.
• Processes claim referrals, new claim handoffs, nurse reviews, and provider complaints.
• Educates & assists providers on our self-service options.
• Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility.
• Performs review of member and provider claim history.

Requirements: • Familiarity with Microsoft Office products • Excellent computer skills using multiple screens and systems • Experience in highly transactional call center environment • Excellent customer service and critical thinking • Secure, private home office location • High speed internet access (100 mbps or higher)

Benefits:
• Full range of medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Paid Time Off (PTO)
• Paid holidays

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