Remote Claims Specialist

Job Summary

The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative expedites the claims process and provides detailed claim notes on all calls; as well as resolves issues and directs calls to an appropriate escalation path as needed.



Essential Functions Duties and Responsibilities

Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims process and servicing processes. Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status. Educates members and providers on client requirements and benefit plans documenting all r...