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MEMBER SERVICE CLAIMS REPRESENTATIVE – HEALTHCARE in Cypress, CA at Beacon Health Options

Date Posted: 12/10/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Member Services Claims Representative to join our team at our office in Cypress, CA

The Member Services Claims Representative will receive inbound calls from providers seeking information on the status of a claim. She/he will submit reprocessing request and will provide copies on any EOB (explanation of benefits) requests; will route any provider calls to the proper department for contract and rate related questions. In addition, the Claims Member Services Representative will be responsible for completing specified assignments that assist the department in meeting contractual goals.

 Position Responsibilities:

  • Intake calls from ACD queues and adhere to telephone performance requirements for call response times and abandonment rates

  • Respond to questions about eligibility, benefits and procedures for accessing behavioral health services  

  • Perform data entry of specified request.

  • Educate providers about alternate claims submission & verification services provided by Beacon/CHIPA.

  • Follow health plan specific contract guidelines

  • Attend all department and general staff meetings

  • Forward patient and provider complaints per health plan guidelines

  • Other administrative duties as assigned by Manager of Member Services

  • Resolve complex claims issues from providers and payors

Position Requirements:

Education: High School Diploma or GED required AA preferred

Relevant Work Experience:   2 years call center experience or 2 years customer service experience in an office setting.  1 year claims experience.

Knowledge, Skills & Abilities:

  • Knowledge in CPT codes, ICD 9 and ICD 10.

  • Knowledge in Claims

  • Quoting eligibility, verifying both member demographic and provider contracting information.

  • Proficient knowledge in Medicare and Medical as well as experience working in a call center environment.

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled