Full-Time Healthcare Customer Service Rep II

• Policy Management Billing: Process member payments, address billing inquiries, and resolve billing discrepancies.
• Member Information Updates: Update member information accurately and promptly, including addresses, phone numbers, beneficiaries, and employment details.
• Policy Terminations and Reinstatements: Handle policy termination requests, process policy terminations effectively, and assist with policy reinstatements.
• ID Card Ordering: Process ID card orders efficiently, ensure timely delivery, and address any ID card-related concerns.
• Benefits Coverage Information: Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions.
• Prior Authorization and Referrals: Assist members with prior authorization and referral processes, guiding them through the procedures and requirements.
• Healthcare Provider Contact Research: Conduct thorough research to locate contact information for healthcare providers, ensuring accurate and up-to-date information for members.

• Claims Status Updates: Provide accurate and timely status updates on claims, explaining the processing stages and addressing any concerns.
• Claims Inquiries: Answer questions about claim processing, explaining claim denials, and providing guidance on submitting appeals.
• Claims Reconsideration Requests: Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.

• Website Troubleshooting: Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems.
• General Questions: Answer general questions about health insurance plans, providing comprehensive and accurate information on various topics.

• Maintain Confidentiality
• Escalate Complex Issues
• Continuous Learning
• Contribute to Team Success

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