Claims Customer Service Representative II (Remote)

The American Medical Association is a nonprofit organization and the nation's largest professional Association of physicians. They are seeking a Claims Customer Service Representative II to provide Claim Call Center services, assist insured with claim problems, and ensure quality claim service is delivered while engaging callers to build strong relationships.

Responsibilities:

• Respond to all incoming phone calls related to claim status inquiry from insured and providers within established response time and quality standards
• Log brief description of calls on CAMS and CAPS systems
• Make outbound calls as needed to support returned checks and resolve claim inquiries
• Refer claims that were improperly handled to AMAI Claim Supervisor for immediate attention
• Fulfill claim form requests for plans not administered by AMA Insurance
• Communicate with insurance carriers or service providers as needed in order to provide feedback on claims administered by carriers
• Handle waiver of premium transactions, cancellations due to death and other claims related transactions
• Update Contact management and customer sending surveys
• Provide information regarding benefits, eligibility, plan provisions, premium billing, and certificate changes as needed
• Process changes to Administration System, including personal and coverage information, sending documents to callers when needed
• Support business operations through participation in special projects as assigned by the Customer Service Supervisor
• Contribute to process improvements and operational efficiencies
• Assist in documenting workflows and service processes to support consistency and quality

Requirements:

• High school diploma or equivalent education required
• Minimum of 2+ years' experience in life, health, or Medicare insurance required
• Demonstrated experience working in a high-volume customer service call center
• Excellent telephone skills including proper telephone technique, multitasking skills and ability to control the call
• In depth understanding of claim adjudication and benefits required
• Demonstrated experience handling customer issues, including technical and financial related issues
• Excellent verbal and written communication skills with a high level of professionalism
• High level proficiency with call center systems, telephony platforms, and personal computers
• Advanced proficiency in Microsoft Office Suite (Word, Excel, Access, PowerPoint) and database systems
• Ability to provide technical support for online tools, systems, and customer-facing platforms
• Strong business process skills, including the ability to document, monitor, and improve workflows
• Excellent planning, organization, and time management skills with the ability to manage multiple priorities in a fast-paced environment
• Ability to build and maintain positive relationships with internal and external stakeholders
• Health or Life insurance license preferred
• Strong knowledge of insurance products, benefits administration, or third-party administration services preferred
• Health insurance knowledge preferred