Healthcare Claims Service Correspondent | Call Center Rep

Claims Service Correspondent - Claims Operations Department

This position is responsible for the accurate and timely response to written claim inquiries received from providers. Incumbent provides support regarding the adjudication and adjustment of claims for the multiple lines of business. The incumbent works closely with Provider Relations, Medical Management, Member Services and the Claims Processing unit

Skills:

• Record and respond to all Customer contacts and update in tracking system. Manage and ensure appropriate follow-up and closure for all customer contacts. • Provide on-site as well as telephone orientations to new and existing members. • Process and resolve complaints and record given information in the system. • Assist members with the selection and assignment of PCP’s. • Update all member demographic changes. • Provide all benefit/service related information to members, perspective members and providers. • Perform retention efforts for all lines of business. • Handle roster Inquiries • Handle disenrollment inquiries from members, providers and regulatory agencies. • Handle provider inquiries. • Schedule marketing appointments for prospective enrollees • Respond to all claim billing inquiries from providers and members • All other duties and special projects as assigned by Associate Executive Director

·   In-depth knowledge of Claims Processing protocols and payment plans

·   Thorough knowledge of Plan Benefits

·   Proficiency in IMAX and TXEN

·   Customer Service Experience

·   Must be able to handle providers complaints in a professional manner

·   Excellent written/verbal communication skills

Education:

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and • Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training and experience. • Proven experience in providing excellent service to customers in various healthcare related areas, (i.e. insurance, doctor’s office, medical clinics)

About RSC Healthcare

Launched in 2018, RSC Healthcare is an RSC Solutions company created to focus on recruiting and staffing across all positions in the healthcare industry. Our knowledgeable staff brings multiple decades of experience within the healthcare industry to assist clients in attaining the highest quality talent in the marketplace.

By leveraging RSC Healthcare’s extensive database and experienced recruiting team for candidate healthcare positions, our clients realize both substantial cost-savings and a streamlined, efficient process. We provide staffing for all levels and positions across your organization, including:

Registered Nurses
Physical/Occupational Therapists
Certified Nursing Assistants
Radiology Technicians
All skilled medical and allied health professionals

As a leader in the healthcare staffing industry, it is our goal is to connect patients with quality caregivers. Our experienced team and industry knowledge allow RSC Healthcare to deliver the qualified healthcare professionals our clients need.