Insurance Customer Service Specialist II

HOW YOU WILL MAKE AN IMPACT

• Resolve customer service issues, expedite the adjustments and follow ups to ensure the resolution; adjudicate required claim adjustments identified through communication with members, employees and clients
• Update and maintain information and knowledge regarding plans and benefits administered by the Insurance Department; educates members and external customers on policies and procedures related to health care program
• Interpret member eligibility and coverage through knowledge benefit plans, Contract Heath Service programs, claims and departmental procedures needed to assist Tribal members, employees and other clients; initiates check tracers and investigate claim payment irregularities
• Collaborate with various FCP Departments to assist in providing Tribal members information needed to ease access to care; assists in the development and communication of resolutions, procedures and policies to internal staff, as requested
• Perform the role as Health Care Coordinator for the Potawatomi Cares Plus program; identifies trends/issues that emerges in calls/correspondence, and informs Supervisor or Director

WHAT YOU NEED TO BE SUCCESSFUL

• High school diploma or GED
• Two (2) year degree in health related or communication field, including a course in medical terminology preferred
• Three (3) years call center customer service experience in a health insurance, physician group practice or hospital setting preferred
• Knowledge of medical terminology, insurance, and billing; NCCI and CMS coding standards
• Knowledge of applicable federal, state, county, and local laws, regulations, and requirements
• Knowledge of all FCPC benefit plans, health programs, eligibility, claims, and departmental procedures