What are the responsibilities and job description for the Claims Call Representative position at IBEW-NECA Service Center, Inc.?
Are you a happy, positive, people person looking to help participants understand their benefits? We are a Taft-Hartley Fund searching for a Health and Welfare team member. The Welfare Department provides excellent customer service to participants, providers, and vendors while processing routine health and welfare claims according to plan guidelines and adhering to policies and regulatory requirements.
- Connect with an average of 50-80 inbound and outbound callers per day, including members and physicians’ offices, professionally and accurately explaining group benefits and confirming eligibility status.
- Build rapport with members as the first point of contact providing a full concierge service that includes everything from assistance with understanding their benefits or reaching out to providers to resolve claim issues.
- Provide outstanding customer service by responding to, and documenting, telephone, written, electronic, or in-person inquiries.
- Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims.
- Processes routine claims which could include medical, vision, prescription, subrogation, Disability, Life/AD&D, or stop-loss.
- Analyze medical procedures and diagnoses using HCSPCs, CPT-4 and ICD-10 codes,
- Pay claims in accordance with plan design,
- Coordinate benefits with other plans, including Medicare.
- Maintain member confidentiality in accordance with HIPAA
- High School diploma or GED
- Excellent customer service skills are a must
- Basic knowledge of benefits claims adjudication principles and procedures, medical terminology, HCPCs, ICD-10 and CPT-4 codes.
- Ability to calculate figures and amounts such as discounts, interest, and percentages.
- Must be able to work in environment with shifting priorities and ability to handle a wide variety of activities and confidential matters with discretion
- Ability to communicate clearly and professionally, both verbally and in writing.
- Possess a strong work ethic and team player mentality with a highly developed sense of integrity and commitment to customer satisfaction.
- Computer proficiency including Microsoft Office tools and applications.
Job Type: Full-time
Pay: $21.25 - $32.19 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $21 - $32