Job Description
Job Description
Abacus Solutions Group is currently seeking a Call Center Representative for a large healthcare system, based out of Allentown, PA. This is a long-term contract position.
JOB SUMMARY: Supports a positive service experience while handling member and provider inquiries via telephone, Customer Service portal, or written correspondence.
JOB REQUIREMENTS:
- Fluency in Spanish (STRONGLY PREFERRED)
- High School Diploma/GED
- 2 years Call center experience
- 2 years Insurance and/or claims administration experience
- Ability to take the initiative to identify and carry out responsibilities to their completion.
- High degree of professional judgement and inter-personal skills at all levels and among all disciplines.
- Banking background and credit background, analytic and customer services skillset will be successful.
JOB FUNCTIONS:
- Handles 80 - 100 calls per day per rep.
- Performs ancillary customer service functions relative to claims, providers, recoveries, and forms or letter generations.
- Uses multiple systems and screens to efficiently handle interaction.
- Offers solutions that aid and facilitate a unique customer service experience, including First Call Resolution (FCR).
- Anticipates needs; educates members and providers about related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
- Engages caller to gather necessary information to guide through plan of benefits, answer questions regarding care needs, and resolve issues.
- Interacts with customers, vendors, and colleagues professionally to ensure questions are answered accurately and in a timely manner.
- Assists with billing questions, claim adjustments, FSA/HSA account, COBRA payments, etc.
- Handles requests related to appeals and pre-authorizations.
- Meets all quality and adherence standards.
- Participates in team and individual discussions related to process improvement.
- Knowledge of insurance or claims administration.