Customer Service Representative I - Claims, Geisinger Health Plan (work from home Pennsylvania resident)

Geisinger is a health plan organization that focuses on providing high-quality healthcare services. The Customer Service Representative I - Claims role involves resolving customer concerns related to claims and ensuring customer satisfaction through effective communication and support.

Responsibilities:

• Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines
• Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups
• Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors
• Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments
• Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules
• Determines the eligibility of most members as well as processing terminations and disenrollments
• Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity
• Determines if services received are covered benefits as applicable by line of business and product design
• Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products
• Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers
• Provides daily support and advice to member and provider services staff regarding claims issues
• Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment

Requirements:

• High School Diploma or Equivalent (GED)
• Minimum of 1 year-Customer Service
• Communication
• Customer Retentions
• Customer Service
• Customer Support Policies
• Standards And Procedures
• Quiet, Dedicated Workspace
• Adequate Workstation Setup
• High-Speed Internet Connection with specific requirements (Download: 75 Mbps, Upload: 25 Mbps, Ping: less than 150 ms, Jitter: less than 30 ms, Ethernet connection required)