Amerit ConsultingRemote
Healthcare Customer Service Representative
United States of America
Full-time
2 weeks ago
No H1B
Key skills
Customer Service ExperienceHealthcare Industry KnowledgeTyping Speed 40+ WPMVerbal Communication SkillsComputer ProficiencyWritten Communication SkillsAdaptabilityCommunication
About this role
Amerit Consulting is seeking a Healthcare Customer Service Representative for a major PBM entity serving over 33 million members. The role involves answering calls related to eligibility, benefits, claims, and providing information while maintaining confidentiality.
Responsibilities:
- Answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers
- Responsibilities also include administration of intake documentation into the appropriate systems
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality
- Resolve customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs
- Educates providers on how to submit claims and when/where to submit a treatment plan
- Informs providers and members on Client’s appeal process
- Links or makes routine referrals and triage decisions not requiring clinical judgment
- Provides information regarding Client’s in-network and out-of-network reimbursement rates and states multiple networks to providers
- Refers callers requesting provider information to Provider Services regarding Client’s professional provider selection criteria and application process
- Refers patients / EAP clients to Client’s Care Management team for a provider, EAP affiliate, or Facility
Requirements:
- At least High School diploma or equivalent (GED)
- Candidate must have 3-5 years of Customer Service experience handling high call volume within Healthcare or Pharma Industry
- Typing speed of 40+ WPM with strong written / verbal communication skills, must be able to talk and type simultaneously
- Flexible and comfortable with change in the ever-changing environment of customer service
- Ability to maneuver through various computer platforms while verifying information on phone calls