DEPARTMENT: CLAIMS
REPORTS TO: CUSTOMER CARE SUPERVISOR
STATUS: NON-EXEMPT
HOURS: T-Sa 9a-6p
Essential Functions:
- Nomination and deselection of medical providers within a formal medical network, which includes reconciling, tracking and documenting transactional activity.
- Provides support over the network call queue in governing states with a medical provider network.
- Establishes customer relations with the policyholder by conducting surveys on service level improvements.
- Provides assistance to stakeholders in selecting a network provider.
- Provides assistance to stakeholders in understanding rules and requirements pertaining to a medical provider network.
- Provides assistance with transfer of care cases by contacting providers to determine availability and requirements for acceptance of a patient, documenting findings in claim file for the handler.
- Documents transactional activity for medical provider inquiries, which includes the nature and type of request, provider demographics, provider specialty, referring physician, and scheduling information.
- Preparation and overview of claims kits and welcome letters to new and renewed policyholders.
- Provides backup to the customer care unit by handling incoming calls in queue for multi-state workers’ compensation claims, intake on new loss overflow and documenting transactional activity.
Competencies / Qualifications:
- Professional telephone demeanor, good verbal and written communication skills, good listening skills, along with strong organizational skills.
- Possess a strong understanding of human nature and motivation principles.
- Readily control/handle problem issues in times of stress and in a climate of conflict and/or adversity.
- Computer literacy including strong familiarity with Microsoft Office Suite.
- Ability to type 45 WPM.
- Responsiveness to changing business needs.
- Ability to work with limited supervision.
- Ability to multi-task while also maintaining attention to detail.
- Ability to adhere to the code of ethical conduct.
Education / Experience Requirements:
- Minimum Education: High School Diploma or equivalent.
- Preferred Education: College degree preferred.
- 1-2 years of customer service experience preferably over the phone.
- Desire for career development within the insurance industry.
Position is located at the home office in Springfield, Illinois.
If interested, please e-mail resume and cover letter with salary requirements to: