Claims Customer Service Representative POST NUMBER: 473441

Currently seeking Healthcare Claims Customer Service Representatives! (MUST HAVE Healthcare claims experience/Medicare/Medicaid) Direct Hire!! "Lots of Growth opportunities"

Key Responsibilities:
Customer Service:

• Handle high volume inbound customer inquiries via phone, ensuring prompt and professional service.
• Provide accurate and comprehensive information about insurance policies, benefits, and coverage.
• Resolve customer complaints and issues within a single call whenever possible, aiming for one call resolution.

Claim Adjudication:

• Demonstrate a thorough understanding of healthcare and other applicable insurance claim adjudication processes to accurately address and resolve policyholder inquiries and issues.
• Assist providers with claim(s) processing, including guidance for claim submission, clarifying reimbursement procedures, and ensuring compliance with Medicare and industry guidelines.
• Educate customers about the claim adjudication process and policy details

Daily Operations:

• Maintain accurate and up-to-date records of customer interactions and transactions.
• Collaborate with other departments, including Medicare Supplement Claims Examiners, Ancillary Examiners, and other stakeholders to ensure seamless service delivery.
• Identify and escalate complex issues to the appropriate department for further resolution.

Vaco has partnered with a well-established insurance organization to fill a Customer Service Representative role supporting policyholders and providers. This position serves as a primary point of contact for high-volume inbound inquiries, delivering accurate information, resolving issues efficiently, and ensuring an exceptional customer experience. The ideal candidate will have strong knowledge of Medicare Supplement insurance and claims adjudication processes, with a focus on achieving one-call resolution. Fluency in both English and Spanish is required. If you are a detail-oriented, empathetic professional with insurance industry experience—apply today.
Responsibilities

• Handle high-volume inbound calls from policyholders and providers, delivering prompt and professional service
• Provide accurate and detailed information regarding insurance policies, benefits, coverage, and claims
• Resolve customer concerns efficiently, striving for one-call resolution whenever possible
• Assist providers with claim processing, including claim submission guidance and clarification of reimbursement procedures
• Demonstrate knowledge of Medicare Supplement insurance and healthcare claim adjudication processes
• Educate customers on claim determinations, policy provisions, and CMS-related guidelines
• Maintain accurate documentation of all customer interactions within customer service systems
• Collaborate with Claims Examiners and other internal departments to ensure timely and seamless issue resolution
• Identify and escalate complex inquiries appropriately
• Uphold company standards of accuracy, integrity, empathy, and professionalism in every interaction
• Stay current on CMS guidelines, Medicare Supplement updates, and internal policy changes

Qualifications

• High school diploma or equivalent required
• Minimum 3 years of customer service experience, preferably in the insurance or healthcare industry
• Strong knowledge of Medicare Supplement insurance and healthcare claim adjudication processes preferred
• Experience handling high-volume inbound calls with a focus on first-call resolution
• Excellent verbal and written communication skills

Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs. With that said, as required by local law in geographies that require salary range disclosure, Vaco/Highspring notes the salary range for the role is noted in this job posting. The individual may also be eligible for discretionary bonuses, and can participate in medical, dental, and vision benefits as well as the company’s 401(k) retirement plan.