GENERAL SUMMARY
Responsible for one or more aspects of service including, but not limited to, processing claims, adjustments, enrollment and eligibility records, reviewing, acknowledging, and reporting receipt of client files, responding to customer inquiries, and resolving customer concerns within a team environment to meet or exceed customer service requirements.
ESSENTIAL RESPONSIBILITIES
- Processes basic/moderately complicated claims, enrollments, and/or adjustments in accordance with company policies and procedures in a timely manner that meets or exceeds productivity and quality goals.
- Researches customer information in response to inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, enrollment, and eligibility.
- Assesses, investigates, and resolves outstanding issues to achieve customer satisfaction.
- Interfaces with customers by telephone and/or correspondence to respond to inquiries and resolve concerns.
- Reconciles all returned checks in a timely and accurate manner.
- Processes and maintains enrollment and eligibility records by ensuring enrollment applications are complete, entering the information into the enrollment system, and resolving basic/moderately complicated enrollment system rejections.
- Monitors account receivables records including claims and overdue invoices; implements collection procedures.
- Acknowledges the receipt of client files. Reviews and completes a daily report on the status of client files.
- Takes responsibility for own self-development. Recommends areas where cross-training is needed. Assists team with implementing a training plan.
- Promotes 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.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous (1-2 years) in claims processing, enrollment, and customer service.
- Ability to maintain production levels and quality goals.
- Knowledge of health care products, medical terminology, diagnosis and procedure coding, and coordination of benefits.
- Ability to establish and maintain effective working relationships.
- Excellent organizational, interpersonal, communication, and problem solving skills.
- Required to pass a battery of job-related tests administered prior to employment.
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: 2013-01-28 00:00:00.0
Job ID: 1310333