As a Customer Service Representative, you interact with customers to provide information in response to inquiries about claims. This is a front line position in our medical department and is crucial in setting the tone for fulfilling our promise of providing exceptional white-glove service to our claimants and callers. You will use your independent judgment and communication skills to obtain information and relay information to claimants and providers.
Responsibilities include:
- Answering incoming telephone calls. Required to login into phone queues (as assigned) daily.
- Providing eligibility and claim information to medical providers and members.
- Reviewing and interpreting plan certificates to determine covered benefits and limitations/exclusions.
- Investigating claim payment issues.
- Research PPO websites/database as required to determine if claims are received and processed by the PPO network.
- Document telephone call reason and details in claim system.
- Monitoring and answering voice mail.
- Review inventory tool for status requests from providers/members and respond professionally.
- Initiate check inquiries (check tracers) from providers and members to determine if claim payment was received.
- Understand HIPAA Regulations and Requirements as it relates to Personal Health information.
- Educate medical providers and members on new technology available to access plan information.
- Use probing skills to identify customer questions/concerns regarding plan coverage/benefits and provide single call resolution.
- Maintain minimum call standards in accordance with company policy, industry standard & other applicable TPA or SLA agreements.
- Complete special projects as required or requested by management.
Successful Candidates Will Have:
- Effective time management skills
- Ability to function independently within established guidelines
- Excellent interpersonal, oral and written communication skills
- Intermediate skill level in Microsoft Office programs
- Problem/issue resolution capability
- Ability to handle multiple tasks, strong organizational/follow up skills
- Ability to work effectively in a fast paced team based environment
- Computer experience with related claims and business software
One80 Intermediaries is part of Arrowhead Intermediaries, a global insurance distribution platform that offers deep specialization, scale, and innovation across wholesale brokerage, program administration, and specialty insurance. With more than 7,000 professionals worldwide and a collective portfolio exceeding $18 billion in premium placed in 2024, our combined organization delivers a diverse trading platform for insurance carriers as well as expanded access and niche solutions for brokers and customers navigating complex and hard-to-place risks. The platform combines entrepreneurial culture with operational excellence to deliver tailored solutions and long-term value across the insurance ecosystem.
Pay Range:
14.09 - 16.00 Hourly
