Employer Service Rep

The Employer Service Representative (ESR) serves within the Customer Service Department handling complex and escalated phone and written inquiries from internal and external customers. The ESR builds and maintains rapport with members, providers, account executives, clients, brokers, employees and other entities. They research and resolve escalated issues with claims, network relations, benefits, eligibility, member experience, etc.

Required:

High School graduate or equivalent. Proficient use of a computer. Written correspondence etiquette. Self-starter and works independently. Detail oriented with excellent problem solving skills. Ability to prioritize and meet deadlines. Maintains confidentiality. Superb oral and written communication skills. Proficient in Microsoft Office products (Word, Excel, Power Point and Office). Easily adapts to changes in work requirements. Can work easily with others and collaborate with team members.

Desired:

Bachelor's degree from an accredited college or university. Previous experience in working with health insurance. Medical Terminology. Knowledge of CPT and

ICD-9/ICD-10

coding. Knowledge of medical and hospital claims.

Responsibility:

Answer all calls and written correspondence in a timely, professional and friendly manner. Communicates with clients, members and providers as necessary to obtain information to resolve issues. Communicate with self-funded networks to research claim processing errors, process network settlements and process pre-service agreements. Works with claims team and core customer service team to manually enter claims in network portals and request written correspondence to process claims. Records and tracks all information clearly and accurately. Understands benefits, eligibility, copay, coinsurance and deductibles in order to relay this information clearly and accurately. Understands claim detail, identifies claims issues and reports issues to the Manager when necessary. Keep all member protected health information (PHI) confidential. Equal Opportunity Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment. 8:00AM - 4:30PM or 8:30AM - 5:00PM 8 hours per day plus a 30 minute lunch.