Claims Customer Service Representative

Description

The Benefit & Claims Customer Service Representative provides information on health and welfare, benefits and claim status to hospitals, providers, and participants. Additionally this position will be responsible for providing high quality customer service while documenting telephone, written and walk-in inquiries regarding benefits, or claim status in an efficient, prompt and professional manner.

Responsibilities

Customer Service

• Provide high quality customer service to all Fund members by documenting telephone, written and walk-in inquiries regarding benefits, or claim status in an efficient prompt and professional manner.
• Respond to and resolve complex issues, including those escalated by members.
• Serve as primary, daily contact to clients on delivery of services.
• Resolve complex plan provision questions and issues addressed.
• Raise issues as appropriate to Team Supervisor or Department Manager.
• Learn and use professional excellence tools and concepts to ensure efficient and quality output/service delivery.

Teamwork

• Work cooperatively with other team members.
• Actively participate in team meetings and training activities.
• Perform additional responsibilities and projects as periodically assigned.

Qualifications

Education/Certification:

• (Minimum) High School Diploma/GED

Skills/Abilities:

• Minimum 40 WPM and 3,000 KPH proficiency
• Prior experience in a medical setting (doctor’s billing office, hospital billing, etc.) is helpful.
• Knowledge of medical terminology preferred.
• Ability to maintain current knowledge of plan benefits to provide correct information to plan participants and providers.
• Professional, client-focused approach to colleagues and assignments.
• Strong oral and written communication skills with exceptional attention to detail.
• Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
• Strong dedication to follow-through on all tasks and assignments.
• Ability to sit for long periods of time operating a computer keyboard.
• Ability to speak, read and write in both English and Spanish preferred.

Employee Benefits Program

• COMPANY PROVIDES Healthcare benefits including MEDICAL, DENTAL ($1,500 per year, $1,000 per year for Plan B), VISION, SHORT-TERM DISABILITY benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for FULL FAMILY COVERAGE.
• COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
• COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
• 401K Plan including company match up to 5%.
• COMPANY PAID additional pension plan entirely funded by the company.
• EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
• Annual, automatic pay increases.

Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.