CUSTOMER CARE CLAIMS REPRESENTATIVE - TPA - SPOKANE Location


Job Summary

This is a hybrid position which includes both Customer Care and Claims administration. Responds and provides follow through to customer inquiries, issues and concerns in a timely and accurate manner. Processes institutional, professional and dental claims.


Main Duties

  • Responds to telephone inquiries per established standards, policies and procedures.
  • Handles challenging customer calls in a clear and courteous manner.
  • Provides feedback to unit Manager regarding plan benefits and system issues.
  • Must comply with strict confidentiality of Protected Health Information.
  • Must be able to work a fixed planned work schedule to ensure customer call loads are able to be effectively managed to ensure call wait time goals are met.
  • Must consistently meet or exceed attendance standards by not having more than two unplanned occurrences per any three month period.
  • Responds to written correspondence from customers as assigned.
  • Researches issues and takes appropriate actions to resolve.
  • Provides accurate information regarding benefits, providers, claims, referrals, eligibility, pharmacy, etc.
  • Documents (online) each contact and outcome.
  • Utilizes on line benefits, policies and procedures.
  • Processing claims types to include Institutional, Professional and Dental claims.
  • Processing all levels of claims procedures to include COB, SARVW, Pre-X, Adjustments and Action Grams.
  • Other projects as assigned.


Requirements

  • High School Diploma or equivalent.
  • Excellent verbal and written communication skills. Experience and training in Conflict Resolution.
  • Minimum 3 years customer service or equivalent experience. Minimum 2 years experience in a TPA or ASP environment.
  • 1 to 2 years current healthcare claims experience, preferably in a managed care environment.
  • Ability to handle multiple priorities in a sometimes stressful environment.
  • Basic computer skills/Word Processing/Windows environment preferred.
  • CPT, ICD-9 and HCPCS proficiency required.


    Our Benefits

    Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.

    Click here to learn more about our competitive benefit package.


    How to Apply

    Please submit your resume to jobs@fchn.com.

    Additional information about our company may be found on our website www.fchn.com