Experienced Senior Customer Service Specialist for Inbound Claims and Client Support – Healthcare Industry Expertise Required

Welcome to blithequark At blithequark, we pride ourselves on being a dynamic team of innovative professionals dedicated to making a significant impact in the healthcare industry. Our purpose is simple yet ambitious: to bend the cost curve in healthcare for all. We strive for service excellence, extending our dedication to all stakeholders – internal and external – driving us to consistently exceed expectations. We foster a culture that is intentionally bold, innovative, accountable, diverse, and empowering, illuminating our collective potential. Join Our Transformational Journey We are on an amazing transformational journey, optimizing opportunities to become a leading technology, data, and innovation voice in healthcare. This is an exciting time to join blithequark, as we continue to grow and evolve. Our team is passionate about what we do, and we are looking for like-minded individuals to join us in our mission to make a difference in the healthcare sector. Job Summary This position is responsible for handling, researching, and communicating complex and escalated claims inquiries stemming from patients, clients, providers, and internal customers, including both intake and resolution. Additionally, this role involves coaching and mentoring less experienced team members, ensuring that our customer service standards are consistently met and exceeded. Key Responsibilities Investigate, analyze, research, and resolve complex and escalated claim inquiries from various stakeholders, including issues related to discounts, payments, and balance billing. Provide resolution and closure to the applicable recipients, creating and executing business correspondence using multiple media formats. Adhere to client turnaround requirements, ensuring timely responses and actions. Document investigative notes and ensure compliance with department standards for production, accuracy, and turnaround time. Perform system claim adjustments based on outcomes and communicate with clients regarding confirmation. Assume and resolve escalated claims and inquiries from team members, serving as a backup for team members or leadership as needed. Coach and mentor less experienced team members on claims handling, resource utilization, and appropriate resolutions. Participate in call center responsibilities, adhering to call center standards, and assist in training new team members as needed. Collaborate, coordinate, and communicate across disciplines and departments to ensure seamless service delivery. Ensure compliance with HIPAA regulations and requirements, demonstrating blithequark's core competencies and values. Job Scope The incumbent works under minimal supervision to complete job responsibilities, applying fundamental knowledge of principles, practices, and procedures related to servicing inquiries and providing resolution and follow-up. Work is complex and requires independent judgment within established guidelines, with the ability to seek guidance from management as needed. This role has regular contact with external and internal customers and may act as a primary contact for priority clients. Qualifications To be successful in this role, you will need: Minimum completion of high school (diploma or GED) Minimum 3 years of experience in the healthcare industry or customer service, preferably with out-of-network claims Required licensures, professional certifications, and/or Board certifications as applicable Bilingual English/Spanish may be required for some positions Knowledge of healthcare claims and appeal procedures Knowledge of insurance company and medical service provider vocabulary desirable Excellent communication, problem-solving, interpersonal, and decision-making skills Ability to create and compose business correspondence Ability to multitask while setting priorities Ability to analyze data and arrive at a logical conclusion Ability to identify issues and determine the appropriate course of action for resolution Ability to elicit trust and credibility with all levels of the organization Ability to work with accuracy in a fast-paced environment Ability to adjust/alter workflow to meet deadlines Ability to work independently as well as part of a team Ability to handle confidential information Ability to handle high-pressure situations and variance in workload volume Ability to use software, hardware, and peripherals related to job responsibilities, including MS Office Skills and Competencies In addition to the qualifications listed above, the ideal candidate will possess: Strong analytical and problem-solving skills Excellent communication and interpersonal skills Ability to work in a fast-paced environment with multiple priorities Strong attention to detail and organizational skills Ability to maintain confidentiality and handle sensitive information Strong coaching and mentoring skills Ability to work independently and as part of a team Career Growth Opportunities and Learning Benefits At blithequark, we are committed to the growth and development of our employees. We offer a range of training and development programs, including live and web-based professional development and educational programs, to prepare you for advancement opportunities. Our goal is to help you achieve your career aspirations while making a meaningful contribution to our organization. Work Environment and Company Culture Our work environment is friendly and supportive, with a strong emphasis on teamwork and collaboration. We offer flexible schedules whenever possible, recognizing the importance of work-life balance. Our company culture is built on a foundation of respect, empathy, and inclusivity, and we are committed to creating a workplace where everyone feels valued and empowered to contribute their best. Compensation, Perks, and Benefits We offer a competitive compensation package, including a salary range of $20.32 per hour, as well as a range of benefits, including: Medical, dental, and vision coverage with low deductible and copay Life insurance Short and long-term disability Paid Parental Leave 401(k) + match Employee Stock Purchase Plan Generous Paid Time Off – accrued based on years of service 10 paid company holidays Tuition reimbursement Flexible Spending Account Employee Assistance Program Sick time benefits Conclusion If you are a motivated and experienced customer service professional looking for a new challenge, we encourage you to apply for this exciting opportunity. At blithequark, we are committed to making a difference in the healthcare industry, and we believe that our team members are instrumental to our success. Join us on our transformational journey and be part of a dynamic team that is shaping the future of healthcare. How to Apply To apply for this position, please submit your application through our website. We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. We are an Equal Opportunity Employer and comply with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability, or protected veteran status. Apply for this job