Description:

The Customer Service Professional (CSP) provides information, education and assistance to members, providers, other insurance companies, attorneys, agents/brokers or other customer representatives on recorded phone lines regarding benefits, claims and eligibility. They also provide excellent and caring services to all internal and external members and providers. These are NOT your everyday customer service positions. We are seeking highly skilled professionals who can provide “white glove” service to Medicare Advantage members while multitasking using web-based tools in a Windows environment.

Duties may include, but are not limited to:

*May communicate with a variety of parties such as subscribers, providers, healthcare providers, agents/brokers, attorneys, group administrators, other member representatives, internal staff and the general public with inquiries regarding benefits, claim payments and denials, eligibility, decisions, and other information through a variety of media – oral, written and on-line communications. Respond to multiple inquiries on all designated lines of business.

*Quickly and accurately assess provider and member inquiries and requirements by establishing a rapport inquirer in order to understand his/her service needs. Identify errors promptly and determine what corrective steps may be taken to resolve errors.

*Apply benefits according to appropriate contract. Determine benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.

*Explain benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to members and providers to ensure that benefits, policies and procedures are understood.

*Educate members and providers on confusing terminology and policies such as eligible medical expenses, hold harmless, medical necessity, contract exclusions and limitations, and managed care products.

*Maintain confidentiality and sensitivity in all aspects of internal and external contacts.

*Manage high volume of calls on a daily basis, prioritize follow-through and document member and provider inquiries and actions on tracking system and/or by completing logs. May generate written correspondence and process document requests.

*Maintain files/records of constantly changing information regarding benefits/internal processes including company-wide internal policies and benefit updates for new or existing business. Work is subject to audit/checks and requires considerable accuracy, attention to detail and follow-through.

Skills:

Call center, Customer service oriented, Customer support, Microsoft office, salesforce crm, radar, health insurance, health plan

Additional Skills & Qualifications:

Education: High school diploma

Experience: 1 year customer service call center experience within insurance, banking, hospital, medical office or other experience with extensive customer service contact.

Keyboarding skills of 30 wpm with 95% accuracy.

Proficient PC skills and prior experience in a PC environment.

Having worked with a duel monitor set up

Demonstrated ability of strong customer-service skills, including courteous telephone etiquette.

Ability to work under stress and pressure and respond to inquiries with tact, diplomacy and patience.

Experience Level:

Intermediate Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.