claims Representative - Healthcare & insurance (Remote )

Remote Full-time
Profile: Customer Service
Location: Remote
Job Description:
Skillset required:
Remote worker verification process to be put in place immediately. Some of these items are already in place but we need to move forward and formalize this visual audit for all new joiners. We will also audit on an annual basis.
Job profile should include the expectation of a remote workspace audit (via webcam or phonecam)
Inspection time less than 5 min

Closed workspace (any room that can be closed by a door, office, bedroom, etc.)

o No shared living spaces unless living alone

If the laptop or screen can be seen from a window it must be covered(shade, blinds, curtains, etc.)


Highspeed Internet verification (screenshot of bandwidth, Fiber, Cable, DSL

o No satellite or mobile broadband connections

Quiet and focused work environment

o No personal responsibilities during working hours
o No barking dogs or other domestic noises
Skillset required:
Profile: Customer Service Analysts / Contact Center
Skillset required:
Productivity Management:

Making outbound phone calls to our members and prescribers


Utilizing multiple software systems to complete Medicare Enrollment case reviews


Meeting or exceeding government mandated timelines


Complying with turnaround time, productivity and quality standards


Conveying resolution to beneficiary or provider via direct communication and professional correspondence


Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

Required Qualifications:

Ability to effectively communicate with members and prescribers while managing multiple software systems


Accountable and results driven


Critical thinker/problem solver


Receptive to constructive feedback and flexible in adapting to change


Ability to effectively plan, prioritize, and organize time and workload


Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment


Proficient in navigation of multiple computer applications


Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors


Ability to type more than 30 WPM

Preferred Qualifications:

At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service


Six months of PBM/pharmaceutical related work strongly desired

Education:

High School Diploma or GED required


Bachelorโ€™s degree in related field or equivalent work experience preferred

PLEASE NOTE:
Computer skills are a must.
Call center experience preferred
Specialized/Practical Knowledge

Should have knowledge on ITES/BPO/KPO/Customer Service /Operations.


Good proficiency on English language.

- Computer literate, should be able to work with different programs and screens with the customer on the line.

Exposure to business domain is an added advantage.


Excellent grasping powers able to understand the various processes.


Team player with excellent verbal and written communication skill.


Should have working knowledge of Microsoft Office skills (excel in particular) and dual monitor handling.


Willing to work in 24/7 environment and sign a service agreement as per company norms.


Ability to work in flexible work schedule, including holidays & weekends

Job Type: Contract
Pay: $13.50 per hour
Benefits:

401(k)
Dental insurance
Flexible schedule
Health insurance
Paid time off
Vision insurance

Schedule:

Monday to Friday

Experience:

Customer Service: 1 year (Preferred)
Call center: 1 year (Preferred)
Data entry: 1 year (Preferred)
Healthcare: 1 year (Preferred)
insurance/Claims: 1 year (Preferred)

Work Location: Remote

Apply Now
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