Health Insurance Claims Customer Service Representative

Aya Healthcare has an exciting REMOTE contract opportunity in the Wisconsin area!! Job Details: JOB TITLE: Health Insurance Claims Customer Service Rep CONTRACT DURATION: 26-weeks SHIFT: Initial training will be 8a-4:30p CT. Once training is complete, there is the expectation that candidates will be available to work variable hours between M-F 8-9p Central Time including weekend shifts. LOCATION: 100% remote ONBOARDING TIME: Expect 3-5 weeks from offer acceptance to start date. PLEASE NOTE: there is the possibility for contract to hire situation, should the candidate and the need align. Because of this, candidates submitted for consideration MUST have a primary residence/tax home in one of the following states: WI, MI, VA, NC, SC, GA, FL, MS, LA, AR, MO, IA, IN, OH, ND, SD, NE, KS, OK, MT, WY, ID, UT, or NV. APPLICATION REQUIREMENTS (due at time of phone screen with recruiter) · Upcoming time off requests for the duration of the contract. · Resume with last seven years of work history - all work history gaps of 90+ days must be explained. REQUIREMENTS & EXPERIENCE EDUCATION: Required: High School Diploma or equivalent; Post High School Education - Vo-Tech or Associate's degree Prefer candidate to have: Associate or Bachelor’s Degree in business administration. EXPERIENCE 1+ year Health Insurance Claims Experience, preferably in a health insurance call center. 2 years’ experience with customer service. Demonstrated proficiency with handling high-pressure situations and with verbal and written communication. Internet Speed: 50mbps download; 10mbs upload – will need to run internet test and verify speeds during interview. DETAILS ABOUT THE POSITION The Health Insurance Claims Customer Service Representative's primary responsibility is to ensure positive customer interactions with one major product line (Medicare Advantage or Commercial/Marketplace) of members. The individual will interact with members, applicants, providers, and agents via telephone. The Customer Service Representative I will identify the customer’s concern and appropriately research and resolve the inquiry in a timely manner. This is a basic learning phase and will be continually trained and coached to enhance customer service skills. The Customer Service Representative I will escalate complex issues to a Benefit Specialist. ESSENTIAL JOB FUNCTIONS 1. Provides accurate and timely answers to benefit, coverage, premium and claims questions in person, via telephone to ensure member satisfaction. 2. Assists with coordinating out-of-area or non-affiliated provider referrals for members requiring care outside of the Security Health Plan service area to ensure members receive needed medical care in a timely fashion. 3. Answers Center for Medicare and Medicaid Services (CMS) test calls in an accurate and timely manner to ensure compliance with CMS guidelines. 4. Assists Federally Facilitated Marketplace (FFM) members in updating financial and subsidy information to ensure compliance with the federal government and the Affordable Care Act (ACA). 5. Documents interactions with members electronically to ensure member records are accurate and available for future use of other staff. 6. Utilizes electronic systems to verify and assist members with questions or concerns regarding wellness benefits to ensure members are reimbursed correctly for wellness activities. 7. Troubleshoots online portal and secure email issues for members to ensure they are able to access and view information electronically. 8. Assists members in filing complaints or grievances using internal and/or federal guidelines to ensure complaints are handled and resolved correctly. 9. Participates in continual coaching to maintain call volume, processing metrics and accuracy goals to ensure compliance with accreditation guidelines. 10. Regular attendance is required in order to carry out the essential functions of the position. 11. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge and abilities to perform, within scope, role specific functions. ADDITIONAL DUTIES 1. May be asked to assist with current Medicare Advantage members with plan changes using documented scripts provided by the Centers for Medicare and Medicaid Services (CMS) to ensure members are enrolled in the correct plan. 2. Other duties as assigned. AYA DELIVERS… · A robust team to support you every step of the way to ensure you start on time, have accurate payroll and an exceptional experience. · A credentialing specialist to streamline the entire compliance process. · And of course, you get the usual benefits such as: o Premium medical, dental, vision and life insurance beginning day one of your assignment. Aya Healthcare is an Equal Opportunity Employer and encourages all to apply! Job Type: Contract Pay: $15.00 - $17.00 per hour Benefits: • 401(k) • Dental insurance • Health insurance • Vision insurance • Work from home Application Question(s): • Can you accommodate the training schedule? Initial training will be 8a-4:30p CT. Once training is complete, there is the expectation that candidates will be available to work variable hours between M-F 8-9p Central Time including weekend shifts. • Is your primary residence/tax home in one of the following states: WI, MI, VA, NC, SC, GA, FL, MS, LA, AR, MO, IA, IN, OH, ND, SD, NE, KS, OK, MT, WY, ID, UT, or NV? • Do you have high-speed internet? Please be prepared to discuss the speed and reliability of your home internet connection as this is a remote position. Education: • High school or equivalent (Required) Experience: • Health Insurance Claims Call Center: 1 year (Required) • Customer Service Representative: 2 years (Required) Work Location: Remote Apply tot his job Apply To this Job