Customer Service Representative
Fairfax , Virginia
February 08, 2017
A large healthcare company in the Mid Atlantic has an immediate need for Customer Service Representatives!

Prior retail, sales and customer service experience is preferred!

* Customer Service Representative Level I implements the company's customer service and retention strategies through telephonic interactions and written inquiries, including but not limited to, enrollment, billing, claims knowledge, claims processing of adjustments, interpretation of benefits and contracts, benefit upgrades, coordination of benefits, research of client history, documentation of all client encounters, and collaboration of medical experts to determine needs for managed care intervention.
The primary challenge for CSR Level I is to learn the business and challenges of the particular product line, to learn the product base, to become proficient at a ┬┐meets standard┬┐ or above in all performance metrics and learn and apply team management skills. At Level I, the scope of the position is focused on the individual and team performance and mastering the ability to work in a fast paced, high volume work environment
* Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments
* Examines adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, provider, medical policy, contracts and policy procedures. Researches, investigates and initiates resolution of pends by the processing system. Calculates and verifies deductibles, maximums, co-payments and coinsurance for resolving inquiries, facilitating adjustments, initiating extra contractual and reporting of any systems processing errors, overpayments and underpayments. Develops and applies the ability to analyze customer contracts and needs involving current product mix, risk assessment, and revenue impact. Develops service techniques and technical competence for the purpose of maximizing customer retention, satisfaction, and potential financial savings.

* Required: High School diploma or equivalent. Minimum of 0-2 years of previous customer service experience in a service or claims environment
* Abilities and Skills: Use of automated systems, PC or CRT proficiency, excellent oral and written communication skills, time management and organizational management skills. Strong analytical ability and problem-solving skills necessary to work effectively in a high volume, fast paced work environment.

Equal Opportunity Employer

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