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Customer Service Specialist - Insurance Claims in Newtown Square, PA at Staffing Now

Date Posted: 12/2/2019

Job Snapshot

Job Description


The Customer Service Specialist position for a 3rd party insurance provider for medical insurance; located in Delaware County, PA and will be responsible for research, resolution and communication of patient, client, provider and internal customer inquiries and any follow-up required thereafter.


RESPONSIBILITIES:


  • Investigate, analyze, research, and resolve claim inquiries as a result of issues related to discounts, payments and balance billing.
  • Provide resolution and closure to the applicable recipients. Create and execute business correspondence to clients or providers using multiple media formats.
  • Defend and uphold discounts that providers have previously accepted to prevent balance billing or reversals, including re-education.
  • Ensure investigative notes related to any contact with providers and clients are documented and accessible throughout the applicable systems.
  • Adhere to client turn around requirements as it relates to response time and required actions.
  • Ensure the maintenance and compliance with department standards for production, accuracy, and turnaround time.
  • Perform system claim adjustments based on outcomes and communicate with client regarding confirmation
  • Serve as liaison between Claims Specialists, Client Service Representatives, and client contacts as needed
  • May include call center responsibilities, including adhering to call center standards.
  • Collaborate, coordinate, and communicate across disciplines and departments.
  • Ensure compliance with HIPAA regulations and requirements.
  • Demonstrate Company's Core Competencies and values held within.
  • Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
  • The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.


  • Requirements:

    • Minimum High School Diploma or GED
    • Minimum 2 years experience in the healthcare industry or customer service, preferably with out of network claims
    • Ability to type well and use computer software, including MS Office
    • Ability to create and compose business correspondence using various programs including MS Office
    • Knowledge of health care claims and health insurance industry
    • Knowledge of insurance company and medical service provider vocabulary desirable
    • Knowledge of claims processing and appeals procedures
    • Communication (written, verbal and listening) problem solving, interpersonal organization, time management and decision-making skills
    • Ability to multitask while setting priorities
    • Ability to handle high pressure situations and variance in workload volume
    • Ability to work independently as well as part of a team

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