Client Service Representative

Client Service Representative

Location: Utah, United States

Job Description:

Job Summary:

We are looking for an experienced and dedicated Client Service Representative with an understanding of employer sponsored medical and dental insurance benefits and claims processing. In this role, you will play a crucial role in supporting our clients and ensuring they receive excellent customer service.

Duties and Responsibilities:

• Answering inquiries: Responding to questions from policyholders, brokers, and providers about the self-funded health plan, including eligibility, benefits, and claims.
• Claims processing: Assisting with the submission, processing, and payment of claims, ensuring accuracy and timely payment.
• Enrollment and eligibility: Handling enrollment inquiries, confirming eligibility, and providing information about the plan's features and benefits.
• Benefit interpretation: Explaining plan provisions, coverage limitations, and out-of-pocket costs to policyholders.
• Provider relations: Communicating with providers regarding claims, benefits, and other plan-related information.
• Issue resolution: Investigating and resolving policyholder complaints and concerns in a timely and professional manner.
• Documentation and record-keeping: Maintaining accurate records of interactions, inquiries, and resolutions.
• Customer service: Providing courteous and efficient service to all customers, ensuring satisfaction and fostering positive relationships.

Qualifications:

• Remote position open to residents located in Utah.
• Strong communication and interpersonal skills.
• Excellent problem-solving and analytical skills.
• Familiarity with health insurance terminology and concepts.
• Ability to work effectively under pressure and manage multiple tasks.
• Knowledge of healthcare industry regulations and compliance requirements.
• Proficiency in computer systems and software related to claims processing and customer service.
• High school diploma or equivalent, with a preference for some college coursework or relevant experience in healthcare or insurance.
• 1-year experience is helpful
• Bilingual, Spanish/English, is helpful though not required
• Self-motivated, goal-oriented, and able to work independently and as part of a team.
• Knowledge of Dental and Medical Insurance Claim Forms (ADA2012, HCFA1500, UB04 & Superbill)
• Knowledge of Dental and Medical Billing Codes (CDT, CPT, HCPCS & ICD-10)
• Thorough understanding of health insurance benefit plans.

Benefits:

• Medical, Dental, Vision
• Life Insurance
• AD&D
• FSA / HSA
• Commuter & Child Care FSA
• Cancer Support Benefits
• Pet Insurance
• Accident & Critical Illness
• Hospital Indemnity
• Employee Assistance Program (EAP)
• 11 Paid Holidays
• Flexible PTO
• 401K