Claims Customer Service Representative (Workers' Compensation)
RESPONSIBILITIES:
- Set up claim files and verify coverage
- Process claim checks
- Answer general claims questions or forward calls to the appropriate contact
- Process incoming and outgoing mail
- Maintain the paperless filing system
- Provide superior customer service for all internal and external customers
- Review and analyze payment of medical charges
- Manage bill review process
- Handle escheats and bulk billing payments
- Prepare Excel spreadsheets and data analysis
- Process and ensure compliance with Medicare SCHIP reporting
- File appropriate State EDI forms and updates
- Provide backup assistance as necessary
QUALIFICATIONS:
Essential:
- High school diploma or GED
- Great keyboard/PC skills
- Superior verbal communication skills
- Excellent problem-solving skills
- Great organization and prioritization skills
- High proficiency in Excel (including complex formulas, data analysis, etc.)
- Must have an A+ team attitude
- Ability to work flexible shift
Preferred:
- Medical claims experience and/or medical records terminology knowledge
- Associate’s or college degree
- Introductory insurance coursework
- Previous customer service experience
- Basic understanding of property and casualty insurance
- Proficient in Spanish, written and verbal