What You’ll Do:

• Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries

• Handle situations which may require adaptation of response or extensive research

• Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines

• Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines

• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes

• Ensure claims are processing according to established quality and production standards

• Identify 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

• Identify and report potential fraud and abuse situations

To Qualify for This Position, You’ll Need:

• Two years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience

• High School Diploma or equivalent

• 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

What We can Do for You:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage

• 401K retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications require proof of semester hours, please attach your transcript to your application.