Customer Service Representative

A large healthcare client in Fairfax, VA is looking for Customer Service Representatives immediately! 

Responsibilities include:


* Customer Service Advisor 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 Customer Service Advisor 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. 
* 25% 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
* 25% 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.
* 25% Effectively utilizes NASCO and/or CARE and/or FLEXX systems, products, contract and medical policy knowledge and processing techniques to resolve client inquiries. Demonstrates the flexibility to process and service various types of products within each line of business according to the established quality, productivity and performance metrics. Learns and retains the ability to access information and effectively administer services using the company’s automated systems.
* 25% Learns information required to effectively provide service to clients as it relates to inquiries concerning pre-existing condition, knowledge of policies and riders, identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions. Appropriately documents all client interactions according to established departmental procedures.
* Work is frequently and closely supervised and audited for quality assurance. Achieves and maintains a minimum of “meets” standard or above in customer satisfaction measures, divisional and corporate performance metrics established by NMIS, ITS, NCQA, accounting audits, performance guarantees, performance contracts and service level agreements. All Service personnel may be required to dedicate up to 100% of their productive time on phone coverage as deemed necessary by the department

* 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. Must have experience in performing job functions that are detailed in nature, requiring strong follow-up skills, active listening and decision making skills based on quality and service expectations
* Preferred: 1-2 years of college in Business or other related field. Healthcare and/or Insurance industry experience preferred. Call Center experience preferred. Bilingual in Spanish, etc. is a bonus
* The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs
* The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.


Equal Opportunity Employer


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Reference number US_EN_99_027071_1259973