Customer Service Specialist - Claims Experience
Houston, TX 77074 | Contract
Pulse Staffing has contract assignments available for experienced health care customer service specialists with insurance and claim experience. This is a call center environment with a hospital in SW Houston.
The position is responsible for:
1.Efficiently and courteously respond to high-volume calls on multiple lines of businesses, from members, providers, and plan sponsor.
2.Interpret appropriate actions that will help resolve members, providers, and plan sponsors issues.
3. Documents communications accurately and completely.
4. Interpret complex claims issues for adjustments and route to appropriate department for processing.
5. Identify accounts that are potentially Fraud Waste & Abuse issues and route to appropriate
department for escalation.
6. Serve as a Subject Matter Expert and Peer to new Customer Service Representatives (Level I).
7. Responds to difficult and complex inquiries raised by internal or external Customer Service staff or
other stakeholders such as brokers, groups, members, and providers.
8. Communicates, collaborates, and cooperates with internal and external stakeholders in a respectful
and responsible manner to enhance relationships and render exceptional service.
9. Adheres to all Compliance/Program Integrity requirements.
10. Complies with HIPAA Regulations.
HS Diploma or GED. 2 years of recent experience in a health care setting working with insurance reimbursement, claims, and customer service.