Claims Resolution Specialist (Customer Service)
Company: The Judge Group
Posted on: September 14, 2022
Location: Orange, CA Description: The Judge Group is currently
seeking a Claims Resolution Specialist (Customer Service) for one
of our clients in Orange, CA! This job will have the following
- Address provider inquiries, questions, concerns in all areas
including enrollment, claims submission and payment, benefit
interpretation, and referrals/authorizations for medical care.
- Verifies member eligibility, claims, and authorization status
for providers. -
- Responsible for thorough follow-up and completion of all
providers inquires or requests.
- Outreaches to Health Network(s), providers, and collection
agencies when appropriate to resolve claims billing, claims
payment, and provider payment disputes. -
- Functions efficiently and productively in a high-volume call
center while maintaining departmental productivity and quality
- Follows up with providers as needed. -
- Responsible for accurate, complete, and correct documentation
into facets regarding all issues, inquiries, complaints, and
- Routes escalated calls to the appropriate departments and/or
- Adheres to company and departmental policies and procedures.
- Other duties or projects as assigned by management.
Qualifications & Requirements:
- 1+ year call center experience with high call volumes or
customer service experience analyzing and solving provider claims
- 2+ years of claims experience required
- Health Maintenance Organization (HMO), Medicare, Medicaid, and
Health Services experience preferred If you'd be interested in this
role and would like to learn more please email me at
email@example.com, or call my direct line at (214) 281-5946 for
immediate consideration. Contact: This job and many more are
available through The Judge Group. Find us on the web at
Keywords: The Judge Group, Orange , Claims Resolution Specialist (Customer Service), Other , Orange, California
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