Customer Service and Claims Representative - Cincinnati, OH

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You like working with people. Even more so, you like helping
them. This is your chance to join a team dedicated to helping our members and
their families every day. As a Customer Service and Claims Representative,
you'll join us on a mission to not only deliver the best customer service in
the health care industry, but the best customer service. Period. Your
compassion and customer service expertise combined with our support, training
and development will ensure your success. This is no small opportunity. This is
where you can bring your compassion for others while doing your life's best work.SM

In this role, you play a critical role in creating a quality
experience for the callers that you connect with and those that you correspond
with. Every interaction gives you that opportunity to improve the lives of our
customers and exceed their expectations. You'll spend your day by responding to
calls from our members and help answer questions and resolve issues regarding
health care eligibility, claims and payments.You'll also spend a portion of your time reviewing, researching and
processing healthcare claims with the goal to ensure that every claim has a
fair and thorough review. 
                                                                                 

This position is full-time (40 hours/week) with our site
Hours of Operation from 7:00 am to 7:00 pm Monday - Friday. We do require our
employees to be flexible enough to work any shift, any day of the week during
those hours. 

• Answer incoming phone calls from customers and identify the
  type of assistance the customer needs (i.e. benefit and eligibility, billing
  and payments, authorizations for treatment and explanation of benefits
  (EOBs)
• Ask appropriate questions and listen actively to identify specific
  questions or issues while documenting required information in computer
  systems
  
• Own problem through to resolution on behalf of the customer in real time
  or through comprehensive and timely follow-up with the member
• Review and research incoming claims by navigating multiple
  computer systems and platforms and accurately captures the data/information
  necessary for processing (e.g. verify pricing, prior authorizations, applicable
  benefits)
  
• Ensure that the proper benefits are applied to each claim by using the
  appropriate processes and procedures (e.g. claims processing policies and
  procedures, grievance procedures, state mandates, CMS/Medicare guidelines,
  benefit plan documents/certificates)
• Communicate and collaborate with members and providers to
  resolve issues, using clear, simple language to ensure understanding
• Meet the performance goals established for the position in
  the areas of: efficiency, accuracy, quality, member satisfaction and attendance 

• Minimum 1 year Customer Service Representative (CSR)
  experience or 1 year experience in an office setting,  call center setting
  or phone support  role
• An education level of at least a high school diploma or GED
  OR 10 years of equivalent working experience
• Familiarity with computer and Windows PC applications, which
  includes the ability to learn new and complex computer system applications
• Ability to work regularly scheduled shifts within our hours
  of operation including the training period, where lunches and breaks are
  scheduled, with the flexibility to adjust daily schedule, and work over-time
  and/or weekends, as needed
• 
  
  All new hires will be required to successful complete the
  Customer Service training classes and demonstrate proficiency of the
  material
• Available to work 40 hours per week anytime within the operating hours of the site (7am to 7pm, Monday-Friday)