Customer Service Rep- Mid to Late May in Meridian, ID at Volt

Date Posted: 5/20/2020

Job Snapshot

  • Employee Type:
  • Location:
    Meridian, ID
  • Job Type:
  • Duration:
    24 weeks
  • Date Posted:
  • Job ID:
  • Pay Rate
  • Contact Name
    Volt Branch
  • Phone

Job Description

To educate providers and members and maintain files regarding Medicare Advantage programs. Be an advocate on behalf of all customers. Initiate communication with members and participate in outreach activities. Accurately respond to written and verbal inquiries received by Medicare Advantage members and providers.

Required Experience: One year call center, customer service, claims processing, medical billing or health insurance industry experience

Required Knowledge, Skills and Abilities (KSAs):
• Data entry
• Written and verbal communication
• Personal computer skills to include application, intranet and internet navigation
• MS Office Suite, to include Word, Excel, Outlook

Ability to:
• Work under limited supervision in an effective and professional manner
• Work scheduled shift which may include evening, weekday, weekends, and/or holiday scheduling

Preferred Qualifications:
• Medicare and Managed Care health plan experience
• ICD-9 (preferably ICD-10) and CPT coding
• Medical terminology
• Bilingual
• Knowledge of NDC codes and pharmacology

• Act as member advocate to identify needs and concerns of members, and work with management to resolve.
• Conduct enrollment verification, inquiry responses, disenrollment and enrollment processes.
• Assist with new member education to include prescription plan education as required.
• Issue letters, member handbook, educational material, and program changes to members.
• Participate in review of developed Medicare Advantage written communication.
• Maintain member files, conduct research and inquiries.
• Understand and follow appropriate privacy rules when speaking with members.
• Assist members with Primary Care Providers and other provider choices.
• Communicate with members and internal departments in a wide variety of inter-related activities to include benefit and service explanations.
• Maintain production levels based upon contact volume, quality and service expectations as outlined by management.

• Assist in the identification of potential third-party payers.
• Identify and/or process grievances and appeals as assigned complying with Medicare Advantage regulations.
• Conduct audits, as requested.
• Perform other duties as requested by the Supervisor.