Claims Service Representative

Carenational Saint Petersburg , FL 33705

Posted 2 weeks ago

Claims Service Representative- Managed Care
St. Petersburg, FL
This is a Full-Time, Benefits Available, CONTRACT-TO-HIRE opportunity,
expected to convert into a PERMANENT role after an established timeframe!

Service (Inbound + Outbound Calls)

Job Summary:

  • Serve as patient advocate working with Health Plan members and their health care providers to bring resolution to balance bills that members receive once their Health Plan has made payment to the provider.
  • Demonstrate consistent ability to act independently within the scope of duties/responsibilities and ensure appropriate resolution to all claims inquiries and issues
  • Respond to inbound calls from health plan members and providers regarding balance bills and take appropriate action to resolve
  • Make outbound calls to health plan members and providers regarding balance bills and take appropriate action to resolve
  • Educate members and providers on Health Plan and Plan payment methodology
  • Work with providers in effort to gain their acceptance of the Health Plan reimbursement methodology
  • Generate provider balance bill letters and correspondence
  • Negotiate with providers within parameters/guidelines of the Health Plan
  • Assure the confidentiality of calls and documents
  • Document all calls in the Patient Advocacy system
  • Liaison with TPA claims Staff
Claims Service Background:
  • Requires an education level of at least a high school diploma or GED.
  • Prefer around 2-3years Healthcare/Insurance Industry experience in patient advocacy, customer service, provider relations, claims or billing/collections.
  • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
  • Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
  • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
  • Must test at a minimum of 35-45 wpm typing with a high level of accuracy.
  • Basic computer literacy (MS Office) and typing skills are necessary.
  • Bilingual in English and Spanish(or other languages beneficial to local population) is a plus.
icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Customer Service Representative

American Strategic Insurance

Posted 1 week ago

VIEW JOBS 3/13/2019 12:00:00 AM 2019-06-11T00:00 Claims Customer Service Representative Schedule: Monday-Friday, 11am-8pm with one 8:30am-5:00pm Saturday shift per month Sponsorship is not available for this position. ASI generally does not sponsor foreign national candidates for work authorization except for positions that in our determination require highly specialized knowledge and for which candidate sponsorship is appropriate. American Strategic Insurance is a leading writer of Property and Casualty products. ASI offers Personal Lines Property products in over 40 states, and is currently in the process of expanding nationally. ASI is ranked a top employer in Florida, and in Tampa Bay, for many years. ASI is an independently-managed insurance company that is a member of the Progressive group of companies. Job Purpose Provides customer service for all inbound, non-coverage-related inquires to the Claims Department. Essential Job Functions Answers incoming calls. Properly captures loss information and sets up various types of claims from policyholder and agents. Provides callers guidance on claims process. Looks up information in the appropriate system (e.g., claim, policy, flood, or other). Performs other duties as assigned. Forwards facsimiles to the appropriate party as needed. Checks adjusters’ voicemails while they are out of the office and determines appropriate action. Helps train new Claims Service Representatives. Job Qualifications Associate’s degree; two years of prior work experience with a history of high performance and high school diploma; or some combination thereof. Service-related experience helpful. Willingness to work flexible shifts, 7 days per week with 12-hour shifts for major catastrophes, and overtime as needed for claim spikes. Ability to grasp concepts quickly, pay attention to details, think through problems logically and make appropriate decisions. Demonstrates integrity. Possesses strong English vocabulary, basic grammar skills, and professional decorum. Writing is clear and easy-to-read. Bi-lingual skills helpful. Strong organizational skills and the ability to multi-task in a fast-paced environment. Demonstrates active listening skills through effective use of questions, reflection, and empathy. Demonstrates a bias toward exceptional customer service; experience providing customer service preferred. Demonstrates the ability to get along with work associates. Proficiency in Microsoft Word and Excel preferred. Basic knowledge of residential construction and repair techniques helpful. The ASI Culture and Benefits The ASI Culture is like no other. While ASI stands for "American Strategic Insurance," we also believe it stands for "Attitude, Speed and Innovation." It is through these principles we plan our day and measure our success. This can be seen through the way our team members interact with each other, the fan letters from our agents and customers, to our success during a time where other companies have struggled. ASI offers outstanding benefits, health insurance for employees and dependents, dental, vision, up to 6% matching on our 401(k) retirement plan, earned time off, life insurance, and much more! American Strategic Insurance Saint Petersburg FL

Claims Service Representative