Open Position: Customer Service Representative

Help Ensure Great Service!

The Alliance moves health care forward by controlling costs, improving quality, and engaging individuals in their health. As a not-for-profit, employer-owned cooperative, we exist to help our members manage their health care dollars while positively impacting their employees’ health.

Do you want to help ensure customers get the healthcare value they deserve? Are you a customer service professional who is committed to resolving problems and concerns? This customer service role may be the right opportunity for you! The Customer Service Representative serves as a primary resource person who resolves provider and member employee problems, questions, and complaints related to the processing of health insurance claims.  This role also serves as an advocate for the consumer and trains employee members to be better health care consumers.  In addition this role:

  • Provides customer service via the telephone; answers questions and solves problems for callers, including issues related to claims, electronic claims filing, re-pricing and claims status.
  • Makes calls to clarify claims or eligibility information.
  • Documents and tracks call data and information.
  • Proactively seeks to identify trends and refers to manager to determine next steps.
  • Assists in the collection of eligibility information.
  • Communicates caller issues with Customer Service team and other departments for resolution and process improvements.
  • Assists Claims Processing Unit
  • Assists with daily mail sort including, but not limited to:
    • Preparing non-standard mail for scanning
    • Responding to written inquiries
    • Determining whether claims are secondary/Medicare prime
    • Forwarding misdirected claims/documentation to appropriate outside entities
    • Routing corrected claims to appropriate internal staff

The ideal candidate will be a well-organized, highly motivated self-starter who is comfortable with detail, results-focused, responsive and service-driven. S/he should possess a proven record of successful customer or member service.  Additionally, well-qualified candidates will possess:

  • Education equivalent of a four-year high school education and at least two years customer service experience in an insurance-related area is required; prior health insurance or health benefits experience is highly desired.
  • Strong interpersonal and verbal communications and listening skills are essential. Must be able to clearly communicate with a variety of external parties, including members (customers) and providers.
  • Must be able to write routine reports and correspondence.
  • Must be comfortable in a fast-paced, deadline-oriented environment.
  • Able to contribute effectively in a team environment.

In this role you’ll be backed by a strong sales, marketing, claims, provider relations and administrative teams. You’ll be part of an organization that is mission-driven, member-centered, respectful, and supportive of our team members.

Interested candidates can apply here.

 Download this job description.

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