What are the responsibilities and job description for the Claims Administrator position at Starkey Hearing Technologies?
General Summary of the Purpose of the Position
As the Claims Administrator for Start Hearing, this position will require excellent customer service as well as strong attention to detail as this role is the liaison between the provider and the payor to work with both parties to obtain patient information, documents and approval for hearing aids and services
This role will require a focus in administering the patients claim with the payor and provider. You will interact with providers and payors to deliver clear and concise information and documentation related to general inquiries regarding new or existing patients.
Additionally, you will be required to understand basic insurance coverage, eligibility, and details of submission processes to access the hearing benefit and communicate the final decision of the request back to the provider based on the payor or contracts decision on the hearing aid/service request.
Approach and Deployment (What to Do & How to Do It)
- Respond promptly and thoroughly to provider, payor and patient inquiries via phone, fax, or email
- Handle all calls with care in a professional manner
- Act as first point of contact for providers, patients, and payors inquiries on new and existing patients
- Reviews requests made by the provider to determine eligibility of request before submission to payor
- May potentially communicate thoroughly with self-insured employers, Third Party Administrators (TPAs’), claimants and adjusters to obtain approval for services and products requested
- Communicate effectively with Start Hearing’s Network Providers regarding technology recommendations & contract requirements
- Provide efficient use of data systems to find and recommend local hearing professionals
- Provide valuable “front line” feedback from patient, providers, and payors regarding fitting of hearing aids or services.
- Be able to support providers and staff on order entry, order status, support sales process, and payment process when necessary
- On an as needed basis, this role may require weekly or monthly meetings with payors and adjusters to review requests that are pending for approval
- Successfully utilize current CRM and B2B2C support tools to track and document provider requests
- Maintain appropriate knowledge of current Start Hearing and competitor hearing aids to be able to answer comparative questions and lead technology discussions toward scheduling appointments with participating network providers
- Understand brand, sales, provider network & patient structure to direct complex inquiries to appropriate staff
Results – Performance Measures (How to Measure Success)
- Less than 5% Abandon Rate
- SLA 80/30
- 80% Availability Rate for Productivity
- Turn Around Time for Email/Voicemail responses – 1 business day
Other Duties (Non-Measurable)
- Support Starkey Employee Corporate and/or Department Guidelines.
- Check and verify quality.
- Support corporate health and safety objectives.
- React to change productively and handle other essential duties as assigned.
Job Requirements
[Knowledge, skills, and abilities for performance of essential duties]
Minimum education, certification, and experience requirements:
Education:
High school diploma from an accredited institution; General education degree
Experience:
Experience in Phone Customer Support Service activities and sales related functions
Knowledge
- Solid computer experience with Windows programs; experience with CRM systems a plus.
- Phone sales process and direct selling
- Good product knowledge preferred but not required
Skills & Abilities
- Excellent customer service skills and great enthusiasm for helping customers
- Must be an energetic “self-starter” with the ability to work both independently and within a team
- Ability to multi-task, problem solver, attention to details and time management are a must
- Strong verbal, written and interpersonal skills
- Strong phone and sales skills
- Previous experience in customer service/support environment
- Should be able to operate well under tight deadlines
