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Medicare Customer Service Professional - Fully Remote in OR, WA, ID or UT

Company: Cambia Health
Location: Spokane
Posted on: November 23, 2022

Job Description:

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 specific information.

Position and training will begin on Tuesday, January 17th, 2023


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 corporation.


* 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 business.

* 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 customer service.

* For HMO related work: Enter, revise and adjust referrals. Explain referral rules and processes to providers and internal customers.


* Keyboarding skills of 30 wpm with 95% accuracy.

* Proficient PC skills and prior experience in a PC environment.

* 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 etiquette.

* Ability to make decisions and exercise good judgment in a complex and constantly evolving environment with the ability to work as a team.

* 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 eligibility issues.

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 resume!

Work Environment

* 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 www.cambiahealth.com/careers/total-rewards.

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 our Privacy Policy. As a health care company, we are committed to 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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