Claims Inquiry Unit Representative

Job Description

Summary:

To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties.

Duties and Responsibilities:

Be proficient in discussion and execution including, but not limited to, the following:

1. Multi-Task in a very busy Call Center Environment

2. Explanation of how the plan works and how to utilize the service

3. Explanation of the Claim process, payment, denials, etc..

4. Explanation/Assist with Benefit clarification, eligibility, verification, and claim status

5. Participate as a team player by demonstrating support to peers, management, and the department's goals

6. Attend meetings and training sessions as scheduled

7. Assist with training new employees as needed

8. Show flexibility in meeting performance objectives consistent with IPA and department objectives

9. Document all Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.

10. Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal.

Minimum Job Requirements:

High school diploma. Two years of Customer Service/Telemarketing sales or related experience. Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10, HFCA1500 Forms, UB94 Claim Forms

Knowledge, Skills and Abilities Required:

Must be computer literate, typing 30 wpm

Excellent telephone techniques

Excellent interpersonal and communication skills; strong writing skills

Medical Front and Back Office as well as Claims/Billing experience preferred

Bilingual in Spanish preferred