Customer Service Representative

Job Title: Customer Service Representative

Job Description:

• Primary job function is answering inbound calls  

• Handle provider inquiries regarding eligibility, benefits and claims for insurance 

• Various off phone projects 

• Checking provider voice mails

• Responding to email inquiries and secured portal messages

• Investigating claim issues and following up with billing offices

• Requesting EOBs

• Call Center staff will be trained on both MA & NH plans

Daily Responsibilities:  

• Receive and respond to all telephone inquiries from members or providers

• Research and provide information regarding member's eligibility, benefits, referrals and authorizations

• Provide members with information on the Provider Network and how to contact and access providers

• Educate providers on prior authorization requirements, how to access services and other routine, non-clinical issues

• Educate providers on process of submitting outpatient treatment requests for outpatient therapy

• Initiate or fax necessary forms to providers for outpatient services

• Coordinate with Provider Relations regarding contracting and/or credentialing status

• Document all members' issues and resolution in the computer systems

• Provide backup support to Data Entry team as necessary

Hours for this Position:

• Monday - Friday, 8:30am - 5:00pm

Compensation: 

• $15 -16/hour (Negotiated based on experience)