• Job Description

  Req#: 25-62902

  Job Profile Summary
  Resolves benefit and claims inquiries via the telephone from our members or providers in the call center. Promotes and maintains a positive company image through direct contact with customers. Complies with all laws and regulations associated with duties and responsibilities.
  Job Description
  Job Description
  POSITION PURPOSE
  Resolves benefit and claims inquiries via the telephone from our members or providers in the call center. Promotes and maintains a positive company image through direct contact with customers. Complies with all laws and regulations associated with duties and responsibilities.
  
  NATURE AND SCOPE
  This role does not manage people
  This role reports to this job: SUPERVISOR, CUSTOMER SERVICE
  Necessary Contacts: Enrollment & Billing, Claims, Provider Relations, Benefit Operations, Network Administration, Sales/Marketing, Accounting and Legal departments as well as members, providers, groups, brokers, other plans, insurance companies, Social Security Administration and Centers for Medicare and Medicaid Services (CMS).
  
  QUALIFICATIONS
  
  Education
  High School Diploma or equivalent required or
  Associate's degree preferred
  Work Experience
  1 year of customer service or medical office experience required
  Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC, can be used in lieu of the one year of experience.
  A certificate in medical office assistant or medical coding can be used in lieu of the one year of experience
  Previous experience in a call center is preferred
  Skills and Abilities
  Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook , etc.) and related software as other corporate software progrms and applications.
  Demonstrated verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
  Familiarity with medical and health insurance terminology preferred
  Conflict resolution skills and remains calm under pressure/stressful situations
  Must be able to to demonstrate critical thinking and problem solving skills
  Demonstrate attention to detail
  The ability to actively listen and ask appropriate questions, to effectively understand issues that are presented from customers.
  Reading comprehension skills are required due to the high amount of direct customer contacts and the need to understand customer contract benefits and training materials.
  Effective organizational and interpersonal skills are required. Must have the ability to multi-task and handle work independently as well as organize and prioritize multiple customer issues.
  Ability to take ownership of issues from the beginning, seeking First Call Resolution (FCR)
  Must be able to verbally communicate on the telephone in a call center environment approximately 95% of the time in the Customer Care Center.
  Employees may be expected to work during inclement weather or other emergency situations when needed.
  Must have ability to successfully complete Customer Service training, with demonstrated proficiency in training materials.
  Licenses and Certifications
  None Required
  
  ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
  Reviews and researches billing and healthcare claim inquiries from members and providers, to ensure proper benefits and/or payments are applied correctly; researches multiple computer systems/applications to verify data/information accuracy.
  Responds to inquiries regarding adjustments, refunds, edits and/or payment registers to ensure completeness, accuracy and customer satisfaction to members or providers.
  Maintains knowledge of required lines of business, changes to applicable company policies/procedures, recent laws and regulations, and related computer systems to ensure information is current and accurate when providing service to members or providers on the telephone in the call center.
  Meet Customer Service performance goals/expectations in the areas of efficiency, accuracy, quality, production, customer satisfaction, and attendance
  The ability to verbally communicate on the telephone approximately 95% of the time.
  Additional Accountabilities and Essential Functions
  The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
  Perform other job-related duties as assigned, within your scope of responsibilities.
  Job duties are performed in a normal and clean office environment with normal noise levels.
  Work is predominately done while standing or sitting.
  The ability to comprehend, document, calculate, visualize, and analyze are required.

  
  EEO:
  
  “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

• About the company

  Mindlance is one of the largest diversity-owned staffing firms in the US . As a recruitment centric talent acquisition company, Mindlance provides Technology, Engineering, Digital / Creative / Marketing, Clinical Research, Scientific, Finance, Professional and Payroll Management staffing services to Global 1000 companies across the US, Canada and India.

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