Education and Experience
High School Diploma and one (1) year of progressively responsible experience performing a variety of duties relating to customer service; OR an equivalent combination of education and experience.
Specific experience in health insurance call centers, customer service, or claims adjudication, preferred.
Knowledge, Skills, and Abilities
Requires considerable knowledge of claims adjudication policies, procedures and processes; intricacies related to medical, dental, pharmacy, mental health, home health, chiropractic claims, and Medicare Supplement claims; medical terminology; various office management systems related to alpha and numeric record keeping; interpersonal communication skills; public relations skills; telephone etiquette; personal computer operations (PC/MS) and various program applications; basic bookkeeping; negotiation techniques; some knowledge of 10 key operation; basic mathematics.
Must have the ability to analyze a variety of claims management issues and problems and make corrections; communicate effectively verbally and in writing; ability to follow written and verbal instructions; establish and maintain effective working relationships with professionals, executives (public and private) department heads, co workers and the public; work independently and deal effectively with stress caused by heavy workload and handling difficult or irate phone calls. Must be able to document calls in computer accurately and succinctly. Must be able to interpret medical and other words related to claims, prior authorizations and appeals.
Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing. Common eye, hand, finger dexterity required to perform essential functions.