Customer Service Rep - Self Funded

Job Details

Customer Service Rep- Self Funded

Department:HA- Customer Solutions

Usual Schedule: M-F 8am-5pm

Regions: Carle Foundation

On Call Requirements: N/A

Job Category: Clerical/Admin

Work Location: HA at The Fields

Nursing Specialty:

Job Post ID: 44430

Secondary Job Category:

Experience Requirements: 3 - 5 Years

Weekend Requirements: N/A

Education Requirements: Not Indicated

Shift: Day

Location: Champaign, IL

Holiday Requirements: N/A

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Check out this job opening for Carle Providers: Customer Service Rep- Self Funded Check out this job opening for Carle Providers: Customer Service Rep- Self Funded

Job Description

JOB SUMMARY:

Responsible for accurately and completely answering and documenting inquiries from members, employers, employer groups and providers. Facilitates communication between self, other departments, members, providers, provider offices, employers, and brokers to ensure that needs of members are met.

EDUCATIONAL REQUIREMENTS

None specified

CERTIFICATION & LICENSURE REQUIREMENTS

Medical Terminology within one (1) year of hire

EXPERIENCE REQUIREMENTS

Three (3) General- Customer Service. Must be proficient in using a computer keyboard, navigating multiple software applications, managing a multi-line phone and completing documentation during the course of a call.

SKILLS AND KNOWLEDGE

Must be able to project a professional, pleasant image, while interacting with a variety of personalities and cultures. Must demonstrate tact and diplomacy in interpersonal interactions, in addition to maintaining composure in confrontational situations.

ESSENTIAL FUNCTIONS:

• Meets standards for documentation, answering and follow-up on all benefit, eligibility, network, and claims inquiries from Health Alliance members and providers generated by telephone, walk-in, or written correspondence.
• Takes action to resolve customer service, claims, or billing complaints by partnering with other departments if and when necessary. Follows up to ensure that appropriate changes were made to resolve the source of the problem. Refers unresolved complaints to the Customer Service Complaint Resolution Specialist or advises members/providers of the right to appeal.
• Educates members and providers regarding a variety of insurance topics, including, but not limited to Healthcare Reform, Exchanges, coordination of benefits and Medicare coordination.
• Processes requests for member materials including, but not limited to ID Cards, federally required Summaries of Benefits and Coverage, Policies, Schedules of Benefits, Provider Directories, Explanations of Benefits, and Remittance Advices.
• Assists members in accessing company websites.
• Consistently meets or exceeds department specific performance and quality requirements.
• Basic communication skills (Telephone Courtesy Guidelines P&P, scripting, and scores/feedback from Quality Assurance Advisor and Customer Service Lead).
• Basic computer skills (all applications used by Customer Service).
• Basic problem solving skills.
• Follows and adheres to accountability structure and required behavioral standards.

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are committed to creating a diverse and welcoming workplace that includes partners with diverse backgrounds and experiences. We believe that enables us to better meet our mission and values while serving customers throughout our communities. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Positions are not available for remote work in the state of Colorado.

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for Medical or Religious exemption will be permitted.

Illinois Required Notices

• Your Rights Under Illinois Employment Laws

Federal Required Notices

• Employee Rights under FLSA
• OSHA
• Employee Rights under FMLA
• EEO It's The Law
• Pay Transparency Nondiscrimination Provision
• Employee Polygraph Protection Act
• Your Rights under USERRA