JOB SUMMARY:
The representative will provide all participants, local unions, providers, vendors and other customer service representatives extraordinary service when he or she is communicating with them via telephone, e-mail, in person and other written correspondence. During each communication, they will provide empathetic and efficient service.
RESPONSIBILITIES:
• To obtain and maintain a working knowledge of the basic plan provisions and multiple benefit schedules, as well as a clear understanding of the eligibility system, claim system, and the Reciprocity system (ERTS)
• Respond timely and accurately to phone calls, e-mail, walk in participants, and correspondence by answering questions; explaining claim payments and claim denials; quote self-payment amounts; verify eligibility and/or benefits; research eligibility or claim issues; update eligibility with outside vendors
• Document all phone calls in the Customer Service module
• Perform various clerical duties (i.e., enter enrollment forms; process working spouse forms, process special fund claims; process disability claims, etc.).
• Navigate and provide accurate information regarding FMCP website
• Monitor incoming calls and calls waiting via call management system
• Pick up and handle messages from nightline
• Work on special projects as requested by Management
REQUIRED AND PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES:
• 1+ years of call center experience in a medical billing or medical insurance call center environment or 1+ years of processing medical claims
• Bilingual speaking candidates strongly preferred
• Bachelor’s degree or equivalent experience required
• Previous TPA or major insurance carrier experience strongly preferred, but not required
• Excellent written & verbal communication skills
• Proficiency in MS Office is required
• Must type 40 wpm
• Demonstrates ability to manage complex issues while maintaining a flexible, positive, and cooperative demeanor
• Responds in a timely manner to operations leaders and stakeholders to facilitate informed decision-making
• Troubleshoots assigned issues, gathers evidence, and investigates all relevant information with participants, vendors, and internal departments to resolve the problem in a cooperative and collaborative mannerReviewed 11/2023
• Dependability – ensures timely arrival and consistent attendance to support the achievement of the team’s goals.
