Position Title Department FLSA Status
Customer Service Representative
Resources - Production
Reports to Date Revised Date Priced Disaster Code
Support Services Supervisor
GENERAL PURPOSE OF POSITION
It is the responsibility of the Customer Service Representative to manage all telephone calls and general correspondence received from members of our Client's health plan and the providers who render treatment to these members.
Provide quality and professional customer service to members and providers, including use of proper telephone etiquette.
Respond to all communications received in a timely and professional manner.
Educate members and providers about healthcare benefits.
Resolve claim issues or concerns that may arise, including the following:
Initiate requests for stop payments, re-issues, and/or check forgery.
Initiate recalculation requests after verifying that benefits were incorrectly paid.
Initiate pricing requests with the network when necessary.
Forward additional information to Claims Examiners for claims reprocessing when necessary.
Research entire file to ensure that all issues are addressed.
Ensure follow-up on all claims issues that need resolution.
Bring issues to the Supervisor's attention.
Back up the Provider Maintenance Specialist by accurately maintaining the integrity of our provider records and updating as needed.
Provide backup in other areas, based on business needs. Other tasks as assigned by Management.
Demonstrate a positive and cooperative work attitude, encourage teamwork among fellow employees and customers.
Back up all dental fax backs to provider.
Back up for all faxes received by Chesterfield Resources.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Additionally, these qualifications are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to communicate effectively with clients, claimants and professionals. Must be proficient in Windows operating systems, or equivalent, and have basic computer skills including data entry. Must be organized, have the ability to multi-task, work independently and problem solve. Must have a basic understanding of medical terminology and be able to read and comprehend basic instructions, short correspondence and memos.
EDUCATION and/or EXPERIENCE: (Required) High School Diploma or General Education Degree (GED) with a minimum of one (1) year experience in a call center for the healthcare industry or comparable environment.
NTT DATA, Inc. (the “Company”) is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.