Customer Service Advocate - Medical Claims - Remote

Overview

This position requires a solid understanding of the healthcare medical claims process, benefits and policy process flows and expertise in healthcare terminology, including ICD-9 and ICD-10 coding.

In Short

• Answer inbound calls and chats from customers including providers, health plans, insurance brokers, and hospitals.
• Provide accurate information about coverage plans, including eligibility and benefits.
• Coordinate resolution of service issues by interfacing with other departments.
• Manage a high volume of incoming claims while adhering to strict deadlines.
• Conduct thorough investigations of claims by reviewing policy details and medical records.
• Determine claim eligibility and appropriate payout amounts based on policy terms.
• Document customer interactions and maintain accurate records of customer accounts.
• Adhere to established quality standards and compliance regulations.
• Participate in quality assurance initiatives to ensure customer satisfaction.
• Assist members with troubleshooting issues related to the member website.

Requirements

• Call Center/BPO Experience is a must.
• At least 2 years of BPO Healthcare experience (Voice).
• In-depth knowledge of healthcare terminologies, eligibility, benefits, and medical claims.
• Willing to work on shifting schedules, including graveyard shifts and weekends.
• Stable internet connection not less than 35mbps.
• Dedicated workspace suitable for remote work.
• Can start ASAP.

Benefits

• Work from home.
• Equipment is provided.
• Transportation Allowance.
• Medical Allowance.
• HMO coverage from day 1 plus 1 dependent.