[Hiring] Customer Service Representative I - Claims @Geisinger

Role Description

Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service in only one of the Primary Functions. Actively participates in cross training, improving processes within the Customer Service team.

• Determines if services received are covered benefits as applicable by line of business and product design.
• Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
• Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
• Provides daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Qualifications

• High School Diploma or Equivalent (GED) - Required
• Minimum of 1 year - Customer Service - Required

Requirements

• Skills: Communication, Customer Retentions, Customer Service

Benefits

• Healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
• Encourages an atmosphere of collaboration, cooperation and collegiality.

Company Description

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.