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Lead Customer Service Representative - Remote Available

Company: SilverSummit Healthplan
Location: North Las Vegas
Posted on: January 12, 2022

Job Description:

Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner.

  • Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments
  • Coordinate the day-to-day work functions, acting as a go to person and investigating and resolving complex issues
  • Initiate change requests to resolve system configuration questions impacting claims processing; review and test results
  • Conduct appropriate auditing processes
  • Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
  • Educate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing procedures
  • Provide first call resolution and own the process by working with appropriate internal/external resources and ensure the closure of all inquiries
  • Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
  • Identify trends related to member and/or provider inquiries to respond proactively and provide feedback to management
  • Collaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around times
    Education/Experience: High school diploma or equivalent. Associates degree or equivalent 2 years higher education and/or work experience in Claims processing, billing, or coding experience preferred. 1.5+ years experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience. Expert in understanding the working of a call center environment. Expert in customer service, verbal communication over the phone. 2+ years of experience in Medicare, Medicaid managed care or insurance environment preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: SilverSummit Healthplan, North Las Vegas , Lead Customer Service Representative - Remote Available, Sales , North Las Vegas, Nevada

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