Provider Call Center Representative

Job description

·  Job Description:

The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs

Responsibilities

·  Ability to follow written policies, procedures and guidelines, and give feedback to leadership.
·  Self-motivated with good time management, organizational skills, and attention to detail.
·  Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
·  Excellent written and verbal communication skills and customer service skills, including professional telephone skills.