PacificSource Health Plans Customer Service Representative Inbound/Outbound - Medicaid, Springfield in Springfield, Oregon
Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.This position requires occasionally working a late shift or weekend hours.
Work efficiently in a high volume call center while maintaining a professional, polite manner.
Assist callers with coverage related questions; accurately interpret policy provisions for group and individual business.
Analyze customer’s inquiries and determine steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and organized.
Document calls in a clear and consistent manner in computer system.
Conduct appropriate research and follow-up for prompt resolution of disputed claims.
Relay information to appropriate departments and personnel using established communication channels and procedures.
As needed, make outbound calls to members dependent upon current outreach campaign.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience:One year medical insurance, other healthcare related field or call center experience required.
Education, Certificates, Licenses:High School Diploma or equivalent required.
Knowledge:Understand insurance and medical terminology, coding and standard medical billing practices. Proficient computer skills, typing, and 10-key required. Medical terminology, CPT/ICD-10 coding preferred.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customer's experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internal and external.
We encourage creativity, innovation, continuous improvment and the pursuit of excellence.
Environment:Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements:Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.