Medicare Customer Service Professional - Fully Remote in OR, WA, ID or UT
Company: Cambia Health
Posted on: November 23, 2022
Remote within ID, OR, WA, or UT. Candidates outside of these
states will not be considered.
Customer Service Professional I starting pay range $16.20-19.80,
DOE and location. Human Resources will reach out and provide
Position and training will begin on Tuesday, January 17th, 2023
WHO WE NEED
The Customer Service Professional I provides information, education
and assistance to members, providers, other insurance companies,
attorneys, agents/brokers or other customer representatives on
recorded phone lines regarding benefits, claims and eligibility.
They also provide excellent and caring services to all internal and
external members and providers.
The Customer Service Professional I is likely to be the primary
contact between the corporation and members and providers. The way
a member or provider is treated during that contact is important to
retaining our customers and to the overall success of the
* Successfully complete training period and meet dependability,
timeliness, accuracy, quantity, and quality standards as
established by department.
* Connect with subscribers, healthcare providers, agents/brokers,
attorneys, group administrators, other member representatives and
internal staff with inquiries regarding benefits, claim payments
and denials, eligibility, decisions, and other information through
a variety of media - oral, written and on-line communications.
Respond to multiple inquiries on all designated lines of
* Quickly and accurately assess provider and member inquiries and
requirements by establishing a rapport in order to understand
service needs. Identify errors promptly and determine what
corrective steps may be taken to resolve errors.
* Apply benefits according to appropriate contract. Determine
benefit payments, maximum allowable fees, co-pays, and deductibles
from appropriate contracts.
* Empower and educate on benefits, rules of eligibility, claims
payment procedures, pre-authorizations, referrals and
grievance/appeal procedures to members and providers to ensure that
benefits, policies and procedures are understood.
* Maintain confidentiality and sensitivity in all aspects of
internal and external contacts.
* Handle large volume of calls, prioritize, follow-through,
document inquiries and actions to include written correspondence
and process document requests.
* Maintain files/records of regularly evolving information
regarding benefits/internal processes including company-wide
internal policies and benefit updates for new or existing business.
Work is subject to audit/checks and requires considerable accuracy,
attention to detail and follow-through.
* Assist in identifying issues and trends to improve overall
* For HMO related work: Enter, revise and adjust referrals. Explain
referral rules and processes to providers and internal
WHAT YOU BRING
* Keyboarding skills of 30 wpm with 95% accuracy.
* Proficient PC skills and prior experience in a PC
* Knowledge of medical terminology and coding preferred.
* Capability to apply mathematical concepts and calculations.
* Effectively communicate with strong oral and written skills.
* Demonstrates strong customer-service skills, including telephone
* Ability to make decisions and exercise good judgment in a complex
and constantly evolving environment with the ability to work as a
* Ability to adapt to a fast-paced environment to work under stress
and respond to inquiries with tact, subtlety and perseverance.
* Ability to exercise discretion on confidential matters.
* Demonstrate initiative in researching and resolving benefit, and
Normally to be proficient in the competencies listed above
Customer Service Professional I would have a high school diploma or
equivalent and 1 year customer service call center experience or 1
year customer service experience such as insurance, retail,
banking, restaurant, hospital medical office or other experience
with extensive customer service contact or equivalent combination
or education and experience. Please apply with the most up to date
* May be required to work overtime.
* May be required to work outside normal hours.
* May be required to work holidays.
This position includes 401(k), healthcare, paid time off, paid
holidays, and more. For more information, please visit
We are an Equal Opportunity and Affirmative Action employer
dedicated to workforce diversity and a drug and tobacco-free
workplace. All qualified applicants will receive consideration for
employment without regard to race, color, national origin,
religion, age, sex, sexual orientation, gender identity,
disability, protected veteran status or any other status protected
by law. A background check is required.
If you need accommodation for any part of the application process
because of a medical condition or disability, please email
CambiaCareers@cambiahealth.com. Information about how Cambia Health
Solutions collects, uses, and discloses information is available in
the health of our communities and employees during the COVID-19
pandemic. Please review the policy on our Careers site.
Keywords: Cambia Health, Spokane , Medicare Customer Service Professional - Fully Remote in OR, WA, ID or UT, Hospitality & Tourism , Spokane, Washington
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