Senior Participant Service Specialist (SPSS) in Burbank, CA at Volt

Date Posted: 9/16/2018

Job Snapshot

  • Employee Type:
    Direct Hire
  • Location:
    Burbank, CA
  • Job Type:
  • Duration:
    N/A
  • Date Posted:
    9/16/2018
  • Job ID:
    132036
  • Contact Name
    Volt Branch

Job Description

Excellent Opportunity as a Sr. Participant Services Specialist (Custom Care) 

Process health insurance claims and answers calls from physicians, hospitals and participants for a multi-employer Fund. Adhere to claim and call policies and procedures while making sound claim/call decisions.Foster strong customer relationships through the resolution of customer incoming call requests. Serve our customers by determining requirements, answering inquiries, resolves problems, fulfilling requests and maintaining key performance measures. Build strong working relationships with others within the company, by demonstrating effective people skills and interpersonal savviness.

Senior Participant Service Specialist is expected to be proficient in the standard job functions for this position.

PRIMARY RESPONSIBILITIES:

  • Elevate and enhance the Health Funds reputation by providing “World Class Customer Service.”
  • Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payment inquiries, authorizations for treatment and explanation of benefits (EOBs)
  • Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information realtime in computer systems
  • Communicate and collaborate with participants and providers to resolve issues, using clear, simple language to ensure understanding  
  • Fulfills requests by clarifying desired  information; completing call logs by entering required data in realtime; forward requests and follows through on all customer commitments
  • Meet all key performance indicators established for this position in the areas of:  efficiency, accuracy , quality, productivity, system adherence, customer satisfaction and attendance
  • Resolves problems by interpreting and clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; addressing unresolved problems
  • Review and research incoming healthcare claims from participants and medical providers by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
  • Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, federal mandates, CMS/Medicare guidelines, benefit plan  documents/certificates)
  • Trains and coaches new staff

SKILLS:

  • Customer Focus, Customer Service, Health Claims Processing, Data Entry Skills, Listening, Phone Skills, Building Relationships, People Skills, Interpersonal Savvy, Problem Solving, Multi-Tasking and Identifies Process Improvements

REQUIREMENTS:

  • 4 years of claim processing and Healthcare Call Center environment experience
  • Strong knowledge of benefits plans, policies and procedures
  • Experience with HMO's & PPO's 
  • Healthcare Background in Claims processes preferred
  • Demonstrated organization and time management skills
  • Proficient with Microsoft products, including Word and Excel
  • Proven verbal and written communication skills
  • High school graduate or equivalent

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work core 8 hour shift schedules within the Participant Service Team, during our normal business hours of 8:30 to 5:00. It may be necessary, given the business need, to work occasional overtime or weekends. 

Volt offers competitive compensation, the chance to work with some of the world’s leading companies, and a friendly staff committed to helping you take the next step on your career path.  

Volt is a global leader in the staffing industry and has earned its reputation as a staffing industry leader by making sure our clients make the right hire, every time. We provide proven, flexible recruiting and workforce management solutions to companies of all size, from innovative startups to Fortune 500 clients.

To see all of our job postings, visit http://jobs.volt.com. To learn more about Volt visit http://www.volt.com.

Volt is an Equal Opportunity Employer.