Claims Service Representative - TPA

This Claims Services Representative requires an individual who has strong interpersonal and organizational skills, the ability to communicate effectively with a variety of personalities, multitask, problem solve and a willingness to adjust from a daily routine when necessary. The individual in this position will have a proactive, forward-thinking approach and a client service mindset. The primary responsibility of the Claims Services Representative is to provide first in class hospitality to internal and external clients, vendors and team members. 

A GLIMPSE INTO YOUR DAY

• Pulls and copies claims for quality assurance technician.
• Handles and resolves first level network, PC and equipment issues.
• Coordinates the internal scanning and retention of paper claims and other miscellaneous documents such as provider contracts, check work and appeals.
• Processes claims based on medical necessity decisions from KP.
• Uses scripts to pay/adjust large amount of claims very quickly, as needed.
• Runs and formats daily claim reports for internal and external review.
• Processes check run activities and distributes associated reports.
• Distributes reports to the Claims staff.
• Performs other projects, duties, and tasks, as assigned.

WHAT SUCCESS LOOKS LIKE IN THIS ROLE

• High School Diploma or its equivalent.
• 1-2 years’ experience in Customer Service with preference given to claims experience.
• Claims experience preferred.
• Excellent written and verbal communications skills are required to maintain effective relationships with clients, co-workers, vendors and others.
• Proficient skills in Microsoft Office Suite (primarily Excel, PowerPoint and Word). 
• Excellent customer service skills.
• Ability to prioritize and handle multiple tasks in a demanding work environment.
• Willingness to adhere to all principles of confidentiality.
• Ability to work independently and on a team.
• Ability to meet deadlines.
• Ability to show initiative, good judgment, and resourcefulness.
• Organized and detail oriented.
• Ability to represent the company well to external organizations, clients and vendors.

WHY CHOOSE RELATION?

• Competitive pay.
• A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more.  
• Career advancement and development opportunities.