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Customer Service Representative

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Kforce HealthcareMiami, Florida
  • Assists callers on inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, explanation of how the plan works and how to utilize services, assists with information regarding referrals or authorizations, member complaints, identification card requests
  • Fluency in English required (verbal & written); French and Creole is a plus
  • Identify, handle, document and/or route Utilization Management inquiries appropriately
  • Identifies the differences between a Grievance, Appeal or Coverage Decision and process the request through the appropriate channels
  • Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies
  • Communicates effectively with other professional and support staff in order to achieve positive customer outcomes
  • Ability to define problems, collect data, establish facts, and draw valid conclusions
  • Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations
Expired 1 year agoInactive Job

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