Note: The job is a remote job and is open to candidates in USA. PacificSource Health Plans is expanding its remote workforce and is seeking Customer Support Representatives to assist members with accessing quality, affordable care. The role involves providing excellent customer service primarily by telephone, interpreting benefits, and resolving claims-related inquiries.

Responsibilities

• Provide excellent customer service primarily by telephone to all PacificSource customers
• Assist customers with coverage/claims related questions
• Accurately interpret benefits and policy provisions for all PacificSource products
• Conduct appropriate research and follow-up for prompt resolution of disputed claims
• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor
• Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products
• Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy
• Keep resource information up to date and well organized
• Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills
• Document calls in a clear and consistent manner in computer system
• Relay information to appropriate departments and personnel using established communication channels and procedures
• Make outbound calls to members as necessary dependent upon current outreach campaign
• Meet department and company performance and attendance expectations
• Be aligned with PacificSource company values
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
• Perform other duties as assigned

Skills

• One-year medical insurance, other healthcare related field, call center or customer service experience required
• High School Diploma or equivalent required
• Basic understanding of insurance and medical terminology, coding and standard medical billing practices required
• Proficient computer skills, typing, and 10-key required
• Strong written and verbal communication skills required
• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor
• Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products
• Analyze customer's inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy
• Document calls in a clear and consistent manner in computer system
• Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims
• Relay information to appropriate departments and personnel using established communication channels and procedures
• Meet department and company performance and attendance expectations
• Be aligned with PacificSource company values
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
• CPT/ICD-10 coding preferred
• Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred

Benefits

• Competitive pay
• Outstanding benefits

Company Overview