Note: The job is a remote job and is open to candidates in USA. PacificSource Health Plans is seeking a Customer Support Representative to help their members access quality, affordable care. The role involves providing excellent customer service primarily by telephone, assisting customers with coverage and claims-related questions, and conducting research for prompt resolution of disputed claims.

Responsibilities

• 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
• 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
• 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
• CPT/ICD-10 coding preferred
• Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred

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