Claims & Customer Service Rep (Medical Benefits)
$63,000–$63,000 year
HybridGlendale, California, United States
Job Summary
Answer incoming phone calls from customers to identify assistance needs regarding benefits, eligibility, billing, and authorizations. Review and research healthcare claims by navigating multiple systems to verify pricing, prior authorizations, and applicable benefits. Ensure proper health benefits are applied using claims processing policies, grievance procedures, and CMS/Medicare guidelines. Collaborate with customers to resolve issues using clear language while researching historical and future benefit trends. This hybrid role requires living in the Los Angeles CA area with mostly remote work. A Bachelor's degree in Healthcare, Math, or Engineering is required, along with four years of claims processing and two years in a call center.
Required Qualifications
- Bachelor's Degree in Healthcare, Math, Engineering or related field
- Minimum of four (3) years of claims processing
- Minimum of four (2) years in heavy call center
- Proficient with Microsoft products, including Word, Excel and Outlook
- Excellent customer service and telephone skills
- Knowledge of medical terminology
- Ability to research and verify claims payment, benefits, and eligibility issues
- Strong knowledge of benefits plans, policies and procedures
- Must live in the Los Angeles CA area
Desired Qualifications
- Minimum of four (2) years of claims processing preferred
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