GENERAL SUMMARY
Responsible for servicing customers by processing enrollment forms and questions, accounts receivable inquiries, or claims and adjustments. Develops and enhances customer relationships by routinely resolving customer inquiries and concerns and striving to exceed customer expectations in all contacts with them. Assists other team members with developing and enhancing customer relationships. Serves as a training resource, mentor, subject matter expert, and coach.
ESSENTIAL RESPONSIBILITIES
- Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail to respond to inquires and resolve concerns, including those of a difficult and challenging nature. Takes responsibility for following through and bringing outstanding issues to closure. Tactfully handles supervisory calls and difficult customer interactions.
- Processes routine to complex claims for all physician, facility and specialty areas, including those requiring difficult manual adjudications, stop loss claims, high dollar claims and adjustments, in accordance with company policies and procedures.
- Researches and updates customer information by effectively using the "Essentials" on-line resource library and Navigator to resolve enrollment and accounts receivable questions and to process claims and adjustments in response to inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, and eligibility. Creates, updates and monitors enrollment,
- accounts receivable, customer service and claims payment training information. Readily assesses and applies information to various customer situations.
- Investigates, analyzes, and resolves outstanding issues to achieve customer satisfaction; uses a systematic approach in solving problems through analysis and evaluation of information and alternate solutions.
- Anticipates and quickly identifies customer needs. Acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making. Assists other team members; takes ownership for problem resolution.
- Performs peer audits including phone quality reviews through the Witness program and claims quality reviews.
- Tests new benefit plans, contracts, rule banks and operational enhancements.
- Monitors and reviews team operational reports including ACD MAX and Navigator phone reports; effectively uses the tools to drive process improvements and enhance results. Assists with phone scheduling.
- Manages work distribution including paper enrollments, claims, correspondence and work queues. Monitors and adjusts workflow accordingly for load balance purposes. Demonstrates expert knowledge of all products.
- Maintains phone and enrollment, accounts receivable or claims quality, production standard and performance levels while working on customer-related and other special projects.
- Assesses training needs within the team. Serves as a training resource, mentor and coach to others, particularly new hires. Identifies and shares best practices.
- Continuously seeks avenues for developing professional expertise and actively pursues new learning opportunities, which support the company's goals and objectives.
- Demonstrates, advocates and reinforces a positive team environment, professionalism and the need to present a positive image of the company when interacting with customers.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- 3-4 years Contact Center enrollment, accounts receivable or customer service and claims processing equivalent experience.
- Demonstrates leadership skills and initiative.
- Excellent planning and organizing skills; uses good judgment.
- Skilled at developing teamwork and achieving results.
- Able to effectively handle multiple tasks; able to locate, analyze and apply information to new and diverse situations.
- Demonstrates effective keyboard skills; ability to navigate within a computer/systems-dependent environment without assistance; experience in a windows-based computer environment.
- Excellent verbal and written communication skills.
- Able to absorb and apply new and changing information; can effectively communicate new information to others.
- Able to quickly think on one's feet.
- Able to help others remain calm and controlled in stressful, unexpected situations; able to resolve conflicts.
- Able to provide constructive feedback and serve as a training resource, mentor and coach.
- Strong analytical and problem solving skills; independent decision making skills.
- Able to maintain regular and consistent attendance in accordance with company and departmental policies and procedures.
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: Tampa, FL, US
Organization: 43000 - CHC Workers Compensation
Schedule: Full-time
Job Posting: 2013-01-14 00:00:00.0
Job ID: 1310149