Description
What You’ll Do :
- Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed.
- Researches to identifying underlying causes, and determine ways to prevent and correct such causes.
- Identifies and reports potential fraud and abuse situations.
- Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met.
- Handles situations that require adaptation of response or extensive research.
- 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.
- Provide feedback to management regarding customer issues.
- Maintain accurate records concerning issues.
- Follow through on complaints until resolved or report to management as needed.
- Maintain knowledge of procedures and policies.
- Assist with process improvements by recommending improvements in procedures and policies.
- Assists in training claims customer service representatives.
To Qualify for This Position, You’ll Need :
- High School Diploma or equivalent.
- 3 years of customer service experience, including 1 year of claims or appeals processing experience 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 abilities.
- Ability to handle confidential or sensitive information with discretion.
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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