claims Representative - Healthcare & insurance (Remote )

Profile: Customer Service

Location: Remote

Job Description:

Skillset required:

Remote worker verification process to be put in place immediately. Some of these items are already in place but we need to move forward and formalize this visual audit for all new joiners. We will also audit on an annual basis.

Job profile should include the expectation of a remote workspace audit (via webcam or phonecam)

Inspection time less than 5 min
• Closed workspace (any room that can be closed by a door, office, bedroom, etc.)

o No shared living spaces unless living alone
• If the laptop or screen can be seen from a window it must be covered(shade, blinds, curtains, etc.)
• Highspeed Internet verification (screenshot of bandwidth, Fiber, Cable, DSL

o No satellite or mobile broadband connections
• Quiet and focused work environment

o No personal responsibilities during working hours

o No barking dogs or other domestic noises

Skillset required:

Profile: Customer Service Analysts / Contact Center

Skillset required:

Productivity Management:
• Making outbound phone calls to our members and prescribers
• Utilizing multiple software systems to complete Medicare Enrollment case reviews
• Meeting or exceeding government mandated timelines
• Complying with turnaround time, productivity and quality standards
• Conveying resolution to beneficiary or provider via direct communication and professional correspondence
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

Required Qualifications:
• Ability to effectively communicate with members and prescribers while managing multiple software systems
• Accountable and results driven
• Critical thinker/problem solver
• Receptive to constructive feedback and flexible in adapting to change
• Ability to effectively plan, prioritize, and organize time and workload
• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
• Proficient in navigation of multiple computer applications
• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
• Ability to type more than 30 WPM

Preferred Qualifications:
• At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
• Six months of PBM/pharmaceutical related work strongly desired

Education:
• High School Diploma or GED required
• Bachelor’s degree in related field or equivalent work experience preferred

PLEASE NOTE:

Computer skills are a must.

Call center experience preferred

Specialized/Practical Knowledge
• Should have knowledge on ITES/BPO/KPO/Customer Service /Operations.
• Good proficiency on English language.

• Computer literate, should be able to work with different programs and screens with the customer on the line.
• Exposure to business domain is an added advantage.
• Excellent grasping powers able to understand the various processes.
• Team player with excellent verbal and written communication skill.
• Should have working knowledge of Microsoft Office skills (excel in particular) and dual monitor handling.
• Willing to work in 24/7 environment and sign a service agreement as per company norms.
• Ability to work in flexible work schedule, including holidays & weekends

Job Type: Contract

Pay: $13.50 per hour

Benefits:
• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:
• Monday to Friday

Experience:
• Customer Service: 1 year (Preferred)
• Call center: 1 year (Preferred)
• Data entry: 1 year (Preferred)
• Healthcare: 1 year (Preferred)
• insurance/Claims: 1 year (Preferred)

Work Location: Remote

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