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DESCRIPTION
- solving inbound tasks and instant messages from our internal team and resolve complex cases regarding claim, benefit, and eligibility issues by using internal tools, health plan insurance systems, and coordinating with our health plan partners
- act as a trusted partner for complex claims and benefit questions and issue resolutions
- act as a liaison to our health plan partners and providers in solving complex claims and benefit issues
- collaborate with teammates, member services teams, health plans, and providers to deliver the best possible service experience for clients of the company
- handle claim disputes with partner health plans on behalf of the client
- ensure compliance with internal and external health plan partner business processes
- develop and maintain solid working relationships and processes with health plans and other payors
- support internal teams with eligibility, benefits, and claims questions and/or issue resolution, including understanding the root cause of the issue
- listen, assess, and comprehend the clients’ presenting issue(s) and use critical thinking, judgment, and problem solving to take appropriate action
- identify opportunities to improve how we resolve claims and benefit issues, including improvements to InView, our benefit content, and other tools and resources
- support of client expectations and health plan processing guidelines
REQUIREMENTS
- excellent knowledge of English language, strong communication skills both in written and verbal
- ability to work independently, organize, and prioritize own tasks effectively
- previous experience in roles where technology, multi-tasking and verbal/written communication is
used to drive their day-to-day responsibilities is an advantage
- general computer literacy
SKILLS
ARE YOU THE PERFECT CANDIDATE?
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