Specialist

Roles & Responsibilities

• · Provides plan and claim information, assists with submission of claims and makes outbound calls to gather missing information on incomplete claims.
• · Conducts research when needed to resolve customer questions or complaints.
• · Responds to telephone inquiries from insured’s regarding specific claim details.
• · Understands processes within entire department to assist callers with questions and triage information received.
• · Works closely with the Claims Reimbursement and Care Managers to provide a seamless customer experience.
• · Outbound calls and letters to customers and providers to research incomplete claims.
• · Escalate complaints and potential complaints appropriately
• · Contributes ideas that enhance service quality.
• · Performs project work and other related duties as assigned or required