Job Description

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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

JOB SUMMARY

The Customer Service Representative provides support to providers and members by answering calls regarding insurance eligibility, benefits, claims, and service authorizations.

DUTIES & RESPONSIBILITIES

• Answering incoming calls from providers and members
• Provides eligibility, claims and authorization status.
• Retrieves voice mails and responds.
• Collaborates with internal and external partners to resolve issues from providers or members as they relate to claims payment, authorization and eligibility inquiries.
• Creates, tracks and completes Customer Service Incidents to internal departments to resolve caller issues.
• Participate in the discovery and resolution of root cause for recurring issues.
• Ensure that all customer needs and problems are properly communicated and managed in a way that maintains great customer relationships.
• Use customer service best practices to ensure a positive customer experience.
• Meets daily, weekly, monthly metrics as written.
• Other duties and responsibilities as assigned.

EDUCATION AND PROFESSIONAL EXPERIENCE

• High School diploma or GED required.
• One (1) to three (3) years in the Health Insurance Industry preferred.
• One (1) to three (3) years of customer service experience required.
• Claims payor experience preferred, but not required.

PROFESSIONAL COMPETENCIES

• Strong communication skills, both verbal and written
• Organized and able to prioritize work to meet deadlines
• Able to work independently with little supervision
• Able to thrive in an often-chaotic environment
• Able to understand regulatory and compliance rules
• Results and detail oriented
• To be positive and accountable
• Team unity

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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