Medical Claims Representative

Robert Half
June 27, 2020
Plainfield, IN
Job Type


Ref ID: 01401-0011480616

Classification: Medical Claims Representative

Compensation: $15.00 to $17.00 hourly

Robert Half Healthcare Practice has partnered with a well-known healthcare company in Plainfield, IN to secure a full-time Medical Claims & Customer Service Representative in a high-volume call center environment! This person receives and responds to customer inquiries via telephone and written correspondence regarding eligibility, benefits and authorization services. This position is primarily onsite, however, it will start remote working from home until the business returns to the office. For this position, the representative must be available to work an 8-hour shift between the hours of 8:00am - 8:00pm. Position Responsibilities include the following: Receive and respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources, Research and provide information regarding member’s eligibility, benefits, referrals and authorizations, Provide assistance to members and/or providers regarding website registration and navigation, Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application, Educate providers on prior authorization requirements, how to access services and other routine, non-clinical issues and process for submitting outpatient treatment requests for outpatient therapy, Maintain performance and quality standards based on established call center metrics including turn-around times, Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment, and Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction. For immediate consideration, please send your resume directly to [Click Here to Email Your Resumé]

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