Description
What You’ll Do :
- Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
- Handles situations which may require adaptation of response or extensive research.
- Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
- Examines and processes claims and / or non-medical appeals according to business / contract regulations, internal standards and examining guidelines.
- Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
- Ensures claims are processing according to established quality and production standards.
- Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.
- Identifies and reports potential fraud and abuse situations.
To Qualify for This Position, You’ll Need :
- High School Diploma or equivalent.
- 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.
- Good verbal and written communication skills.
- Strong customer service skills.
- Good spelling, punctuation and grammar skills.
- Basic business math proficiency.
- Ability to handle confidential or sensitive information with discretion.
- Two years customer service experience in an office environment. (Can be concurrent)
What Blue Can Do For You :
- 401(k) retirement savings plan with company match
- Subsidized health plans and free vision coverage
- Life insurance
- Paid annual leave the longer you work here, the more you earn
- Nine paid holidays
- On-site cafeterias and fitness centers in major locations
- Wellness programs and a healthy lifestyle premium discount
- Tuition assistance
- Service recognition
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