Customer Service Representative (With Healthcare Experience)

Duties & Responsibilities:

Responsible for researching and investigating other coverage for all of the company's groups and members.Performs multi complex functions and interprets complex rules, laws and contracts.Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership and accounting. Primary duties may include, but are not limited to: Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage. Aides members in enrolling in Medicare when they are entitled.Updates all of the company's membership system components with investigation results for claim coordination. Ensures correct forms are provided to assist members enrolling in Medicare. Reviews claim history to reconcile processed, pended or recovered in any error.Associate must identify the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines. 

Qualifications:

Requires a HS diploma or equivalent; 1 year of claims processing and/or customer service skills1 year coordination of benefits experience; or any combination of education and experience, which would provide an equivalent background.Requires knowledge of NAIC & CMS COB guidelines; excellent oral and written communication skills and skill in using PC, database system, and related software (word processing, spreadsheets, etc.).