perform installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations
investigate and settle claims and customer service issues
research customer inquiries to resolve claims issues
provide updates to business partners and leadership
document and track issues relating to financial, system and beneficiary data
coordinate and present research findings to internal and external customers
make recommendations based on root cause analysis related to policies, procedures, claims, provider, and beneficiary data

U.S. citizenship for this position
Successfully receive interim approval for government security clearance (NBIS
National Background Investigation Service)
3 years of experience in managed care environment
3 years of claims experience processing/adjudicating professional, inpatient, and outpatient claims
Experience with TRICARE contracts and/or the military health care delivery system, or Medicare reimbursement
2 years of customer service experience
Familiarity with reimbursement terminology (ie DME, DRG, HCPCS, CPT coding, Revenue codes, etc)

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
short-term and long-term disability
life insurance

Consumer Service Operations Professional

Key skills