Resolve complaints and inquires and provide education to members, prospective members, providers, other insurance carriers, agents, brokers, attorneys, employer groups and other member or provider representatives in writing, in person and over the telephone. Health plan related issues may include medical coverage, claims, referrals or eligibility.
Delivery system issues may include appointment access, medical center service complaints, physician selection, fee quotes and patient billing issues. Governance issues may be voting member information or consumer governance policies.
Responds to health plan, delivery system, and governance inquiries and complaints in writing and over the telephone.
Researches issues. Interact with other departments, physicians or administrators as needed. Resolve or escalate when appropriate.
Identify errors and determine what corrective steps need to be taken to resolve.
Interpret and apply all benefits according to appropriate contract.
Document all interactions in contract tracking system according to regulatory guidelines.
High School Diploma/GED
License, Certification, Registration
Analytical, communication and problem solving skills.
Ability to exercise discretion.
Two (2) years of call center experience in a health care or insurance environment.
Associate's or bachelor's degree.
Primary Location: Washington,Renton,Renton Administration - Rainier 2715 Naches Ave.
Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule:
Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation:
Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: Customer Services Department:
Member Services Travel: No
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