GENERAL SUMMARY
Responsible for all aspects of recoveries service including, but not limited to the following: working duplicate and retro-termination reports, refund and return check processing, stop payment/void processing, responding to customer inquiries, and resolving customer concerns.
ESSENTIAL RESPONSIBILITIES
- Uses Pegasus and hard copy contracts for Provider Contract interpretation. Must be able to interpret medical contract language.
- Performs adjustments on all IDX Platforms. Must possess IDX technical and claims processing expertise.
- Understands the accounts payable process including, but not limited to, coordinating with individual Health Plan Finance areas and meeting with Health Plans regarding open payable items.
- Completes assigned projects/reports i.e. duplicate reports, retro termination reports, etc.
- Processes Provider Refund and Return Checks.
- Processes stop payment/void requests.
- Answers telephone when calls are in queue through the Coventry established Recovery line. Interfaces with customer by telephone and/or written correspondence to respond to inquiries and resolve concerns.
- Researches customer information by effectively using the “Essentials” on-line resource library and customer service console.
- Assesses, investigates, and resolves outstanding issues to achieve customer satisfaction. Uses a systematic approach in solving problems through analysis and evaluation of alternate solutions.
- Promotes a positive team environment; seeks out ways to continuously improve teaming.
- Understands the team’s performance against measured service operation goals; accepts ownership for individual and team results; identifies and initiates process improvements.
- Maintains quality goals and production.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous (2 to 3 years) medical claims processing and adjustment experience required.
- Previous customer service experience or equivalent preferred.
- Excellent organizational, interpersonal, communication and negotiation skills.
- Demonstrates effective keyboard skills; ability to navigate within a computer systems dependent environment without assistance; experience in a windows based computer environment.
- Displays a positive, confident attitude; highly self-motivated, flexible, and accountable.
- Ability to absorb and apply new and changing information.
- Responds positively to goal-setting and performance measurement.
- Strong analytical and problem solving skills. Results oriented.
- Independent decision making skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Administrative Support Workers
Primary Location: Rockville, MD, US
Organization: 42040 - Claims Administration Corp.
Schedule: Full-time
Job Posting: 2012-12-19 00:00:00.0
Job ID: 1212700