Claims Inquiry Unit Representative

Summary:

To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties.

Duties and Responsibilities:

Be proficient in discussion and execution including, but not limited to, the following:

· Multi-Task in a very busy Call Center Environment

· Explanation of how the plan works and how to utilize the service

· Explanation of the Claim process, payment, denials, etc..

· Explanation/Assist with Benefit clarification, eligibility, verification, and claim status

· Participate as a team player by demonstrating support to peers, management, and the department's goals

· Attend meetings and training sessions as scheduled

· Assist with training new employees as needed

· Show flexibility in meeting performance objectives consistent with IPA and department objectives

· Document all Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.

· Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal.

Minimum Job Requirements:

· High school diploma.

· Two years of Customer Service/Telemarketing sales or related experience.

· Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10

Skills and Abilities:

· Must be computer literate, typing 30 wpm

· Excellent telephone techniques

· Excellent interpersonal and communication skills; strong writing skills

· Medical Front and Back Office as well as Claims/Billing experience preferred

· Bilingual in Spanish preferred

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