Customer Service Representative I - Claims / Geisinger Health Plan (Work from Home Pennsylvania resident)
Location: Danville, Pennsylvania
Type: Full Time
Internal Number: R-21089
.Geisinger Health Plan is looking for skilled customer service representatives to join their Claims team. This is an excellent entry level opportunity where one can grow a career in health insurance..Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service. Actively participates in cross training, improving processes within the Customer Service team.
Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors.
Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules.
Determines the eligibility of most members as well as processing terminations and disenrollments.
Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity.
Determines if services received are covered benefits as applicable by line of business and product design.
Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
Provides daily support and advice to member and provider services staff regarding claims issues.
Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:
5 MBPS UP
20 Mbps DOWN
<75 ms Ping Required
<30ms Gitter Required
Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection
High School Diploma or Equivalent (GED)- (Required)
Minimum of 1 year-Customer Service (Required)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13... hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.