Pacificsource · Wfh:, FLPrepare for this interview
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Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! 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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. 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. Essential Responsibilities: Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor. Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products. Analyze customer's inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized. Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills. Document calls in a clear and consistent manner in computer system. Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims. Relay information to appropriate departments and personnel using established communication channels and procedures. Make outbound calls to members as necessary dependent upon current outreach campaign. Supporting Responsibilities: Meet department and company performance and attendance expectations. Be aligned with PacificSource company values. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred. Education, Certificates, Licenses: High School Diploma or equivalent required. Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills. Competencies: Building Customer Loyalty Building Strategic Work Relationships Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
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