Customer Service Representative

One80 Intermediaries is part of a global insurance distribution platform that specializes in wholesale brokerage and specialty insurance. They are seeking a Customer Service Representative to provide exceptional service to claimants and callers, handling inquiries about claims and ensuring accurate communication of eligibility and benefits.

Responsibilities:

• Answering incoming telephone calls. Required to login into phone queues (as assigned) daily
• Providing eligibility and claim information to medical providers and members
• Reviewing and interpreting plan certificates to determine covered benefits and limitations/exclusions
• Investigating claim payment issues
• Research PPO websites/database as required to determine if claims are received and processed by the PPO network
• Document telephone call reason and details in claim system
• Monitoring and answering voice mail
• Review inventory tool for status requests from providers/members and respond professionally
• Initiate check inquiries (check tracers) from providers and members to determine if claim payment was received
• Understand HIPAA Regulations and Requirements as it relates to Personal Health information
• Educate medical providers and members on new technology available to access plan information
• Use probing skills to identify customer questions/concerns regarding plan coverage/benefits and provide single call resolution
• Maintain minimum call standards in accordance with company policy, industry standard & other applicable TPA or SLA agreements
• Complete special projects as required or requested by management

Requirements:

• Effective time management skills
• Ability to function independently within established guidelines
• Excellent interpersonal, oral and written communication skills
• Intermediate skill level in Microsoft Office programs
• Problem/issue resolution capability
• Ability to handle multiple tasks, strong organizational/follow up skills
• Ability to work effectively in a fast paced team based environment
• Computer experience with related claims and business software