Claims Customer Service Representative

• Provide claims information through telephone inquiry from providers of service.

• Provide claim information through inquiries receive via facsimile from providers of service.

• Recognize potential problems and refers them to the appropriate person to include Claims Management for resolution, and follows up to assure resolution.

• Maintains a broad knowledge of all systems used in the adjudication of claims.

• Maintains quality standards of claims calls handled.

• Maintain a log of calls for use in the reporting and tracking of calls handled.

• Liaison to other departments outside of the claims department.

• Provides back-up to the Claims Department staff, (claims examiners, data entry & clerical)