Customer Service Representative (000302)

Duties:
First point of contact for all customer service issues. Responsible for ensuring patient/client medications, supplies and equipment are accurately recorded and sent to distribution. Consults with Supervisors to ensure timely and accurate delivery of supplies/equipment. Maintains patient privacy and confidentiality at all times according to established procedures. Provides positive, supportive communication to supervisor, patients, families, visitors and company personnel This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected pay range may vary and/or include certain benefits like: Medical, Dental, Vision, 401K [include any compulsory benefits such as commissions, incentive bonuses, etc. if applicable].
This position is responsible for the accurate and timely response to written claim inquiries received from providers. Incumbent provides support regarding the adjudication and adjustment of claims for the multiple lines of business. The incumbent works closely with Provider Relations, Medical Management, Member Services and the Claims Processing unit

Scope of Role & Responsibilities:
Act as a key liaison and service representative for all written provider inquiries and problem resolution.
Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.
Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, utilization management)
Manage and ensure appropriate follow-up and closure for all inquiries
Respond to Provider Inquiries in writing; maintain accurate files
Data Entry into the IMAX system.
Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
Participate in Special Projects involving Claim Status Investigations.
Resolve Member Bills referred from Member Services.

Skills:
One year experience
In-depth knowledge of MetroPlus Claims Processing protocols and payment schemes.
Thorough knowledge of Plan Benefits.
Proficiency in IMAX and TXEN.
Customer Service Experience a plus.
Must be able to handle irate providers in a professional manner.
Excellent written/verbal communication skills.

Education:
High School Diploma/ GED
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Languages:
English Read Write Speak