Elite Business Resources, LLC
Elite Business Resources, LLC is hiring: Customer Service Representative in Boss
Elite Business Resources, LLC, Bossier City, LA, United States
Job Description
Job Description
We are seeking a dedicated and compassionate Medical Benefits Customer Service Representative to join our team. In this role, you will be the first point of contact for members, assisting them with inquiries related to their medical benefits, claims, coverage, and eligibility. You will provide support, information, and guidance to help members understand and make the most of their health plan benefits. The ideal candidate is patient, empathetic, detail-oriented, and committed to delivering excellent customer service.
Key Responsibilities:
- Answer Member Inquiries: Respond promptly to phone calls, emails, and other communications from members regarding their medical benefits, coverage options, claims, and eligibility.
- Educate Members: Provide accurate and comprehensive information to help members understand their benefits, policy details, and available options.
- Claims Assistance: Assist members with questions about claims, explain claim status, and help resolve issues related to claim processing or denial.
- Eligibility Verification: Verify member eligibility for benefits, including pre-authorizations, copays, deductibles, and coverage limits.
- Data Entry and Documentation: Accurately document all member interactions, inquiries, and resolutions in the customer service database, maintaining confidentiality and compliance with HIPAA standards.
- Resolve Issues: Collaborate with other departments as needed to resolve member issues quickly and effectively, escalating complex cases to supervisors when necessary.
- Policy and Procedure Compliance: Follow company policies, procedures, and guidelines for customer interactions, ensuring adherence to regulatory standards.
- Continuous Improvement: Identify opportunities for process improvements and provide feedback to enhance the customer experience.
Qualifications:
- Education: High school diploma or equivalent required; associate or bachelor's degree in healthcare, business, or a related field is a plus.
- Experience: 1-2 years of customer service experience, preferably in healthcare or insurance.
Key Responsibilities:
- Answer Member Inquiries: Respond promptly to phone calls, emails, and other communications from members regarding their medical benefits, coverage options, claims, and eligibility.
- Educate Members: Provide accurate and comprehensive information to help members understand their benefits, policy details, and available options.
- Claims Assistance: Assist members with questions about claims, explain claim status, and help resolve issues related to claim processing or denial.
- Eligibility Verification: Verify member eligibility for benefits, including pre-authorizations, copays, deductibles, and coverage limits.
- Data Entry and Documentation: Accurately document all member interactions, inquiries, and resolutions in the customer service database, maintaining confidentiality and compliance with HIPAA standards.
- Resolve Issues: Collaborate with other departments as needed to resolve member issues quickly and effectively, escalating complex cases to supervisors when necessary.
- Policy and Procedure Compliance: Follow company policies, procedures, and guidelines for customer interactions, ensuring adherence to regulatory standards.
- Continuous Improvement: Identify opportunities for process improvements and provide feedback to enhance the customer experience.
Qualifications:
- Education: High school diploma or equivalent required; associate or bachelor's degree in healthcare, business, or a related field is a plus.
- Experience: 1-2 years of customer service experience, preferably in healthcare or insurance.
Skills:
- Excellent communication skills, both verbal and written.
- Strong problem-solving skills and attention to detail.
- Proficient in basic computer applications and data entry.
- Ability to handle high-volume calls and work efficiently under pressure.
- Excellent communication skills, both verbal and written.
- Strong problem-solving skills and attention to detail.
- Proficient in basic computer applications and data entry.
- Ability to handle high-volume calls and work efficiently under pressure.