Claims Customer Service Rep

Job DescriptionJob Title: Claims Customer Service RepresentativeDepartment: Claims Effective Date: January 12, 2022Reports to: Claims Support SupervisorDirect Reports: NoneFLSA: Non-ExemptWorking Conditions: Normal, no adverse or hazardous conditions.Primary Purpose: To provide high level customer service to PDTs’ clients in accordance with accuracy. Principal Duties and Responsibilities (* = essential functions): Answer calls from members, providers and health plans regarding specific claim issues. Route and redirect calls as necessary.* Return calls from the Claims voicemail box.* Perform timely follow-up on calls requiring research and call back.* Accurately interpret DOFRs – Division of Financial Responsibility documents that determine who pays for specific health care services (PDT, health plan or other). * Use MedMC software to log incoming call and resolution of the call. * Act as back-up resource to cover front desk phones/greet walk-in guests, data entry of paper claims and open/sort/batch incoming claims mail. Complete other tasks as assigned. Job Specifications (KSAs): Requires the ability to speak, read, write and understand English and other general educational skills as is generally obtained by completing high school or a GED. Knowledge of health or managed care industry as generally obtained through 1-2 years of work experience. Position Performance Criteria: Consistently produces accurate and timely work product as it relates to departmental goals. Demonstrates high reliability through consistent punctuality and attendance. Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow through. Demonstrates excellent interpersonal skills as discerned through observation and team project successes. Accurately interprets and applies departmental policies and procedures using sound judgment. Communicates clearly, professionally and respectfully to peers, superiors, subordinates and clients. Demonstrates overall professionalism in attitude, demeanor and personal appearanceMonday - Friday