NEW JOB OPENING CUSTOMER SERVICE REPRESENTATIVE IN Remote, USA!

Job Description

Required Education:• High School or GED equivalent.Preferred Experience:• Healthcare insurance and call center experience is preferred.Required Qualifications/Skills/Experience:• Customer Service experiences in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate.• Experience in a production environment.Duties:• Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages result in rework for the appropriate staff.• Documents and tracks contacts with members, providers, and plan sponsors. The CSR guides the member through their member's plan of benefits, Client policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.• Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members'' best health.• Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member.• Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.• Uses customer service threshold framework to make financial decisions to resolve member issues.• Explains members' rights and responsibilities by the contract.• Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via the target system.• Educates providers on our self-service options; Assists providers with credentialing and recredentialing issues.• Responds to requests received from the Client's Law Document Center regarding litigation and lawsuits.• Handles extensive file review requests.• Assists in the preparation of complaint trend reports. Assists in compiling claim data for customer audits.• Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility for incoming correspondence and internal referrals.• Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.• Reviews member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.Industry: Healthcare Estimated Start Date: 06/23/2025Dress Code: NA Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements. Benefits: For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department via our secure website . California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here . Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department . Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.). Apply Job! Apply to this Job