客户服务代表I - 医疗补助注册，Geisinger健康计划
Customer Service Representative I - Medicaid Enrollment, Geisinger Health Plan (
位置：
居家办公（宾夕法尼亚州）
班次：
白天（美国）
每周计划工作时长：
40小时
员工类型：
正式员工
是否为豁免职位：
否
职位概述：
协助解决客户问题，提供适当的教育/指导，并通过提供最高水平的客户服务来保持客户满意度。积极参与交叉培训，提升客户服务团队内部流程。
职位职责：
- 按照政策和程序以及任何州立法的覆盖范围和资格指南，解决和核对注册报告及相关资格问题。
- 向新注册的健康计划成员、其家属和雇主团体发起沟通并提供相关资料。
- 解释并正确应用合同协议中的规则和规定，以及与雇主团体和供应商的条款。
- 执行会员数据提取报告，并将其提供给雇主团体，作为确保准确性和符合绩效风险保证承诺的审计工具。
- 更新、审批并解释由雇主团体模块中的在线软件功能生成的会员数据和工作流程。
- 确定大多数会员的资格，并处理终止和退保事宜。
- 准备、生成并适当分发与注册活动相关的信件通信给订阅者和会员。
- 确定所接受的服务是否属于适用业务线和产品设计的覆盖福利。
- 审查被暂停的索赔，通过应用适用于特定产品的当前政策、程序和福利进行解决。
- 提供团队建设资源，以帮助引导同事正确使用索赔解决政策和程序，从而协助会员和提供者。
- 为会员和提供者服务人员在索赔问题上提供日常支持和建议。
- 研究参与提供者的索赔问题，并确定重新考虑支付的具体标准。
工作通常在办公室环境中进行。需履行所有岗位特定职责，并遵守所有组织的政策和程序。本职位描述中的具体陈述并非旨在涵盖所有内容。它们代表了成功履行该职位所需的一些典型要素。
职位详情：
教育：
高中文凭或同等学历（GED）-（必需）
经验：
至少1年-客户服务（必需）
查看英文原文
Location:
Work from home (Pennsylvania)Shift:
Days (United States of America)Scheduled Weekly Hours:
40Worker Type:
RegularExemption Status:
NoJob Summary:
Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service. Actively participates in cross training, improving processes within the Customer Service team.Job Duties:
- Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
- Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
- Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors.
- Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
- Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules.
- Determines the eligibility of most members as well as processing terminations and disenrollments.
- Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity.
- Determines if services received are covered benefits as applicable by line of business and product design.
- Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
- Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
- Provides daily support and advice to member and provider services staff regarding claims issues.
- Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Position Details:
Education:
High School Diploma or Equivalent (GED)- (Required)Experience:
Minimum of 1 year-Customer Service (Required)Certification(s) and License(s):
Skills:
Communication, Customer Retentions, Customer Service
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.
- KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
- EXCELLENCE: We treasure colleagues who humbly strive for excellence.
- LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
- INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
- SAFETY: We provide a safe environment for our patients and members and the Geisinger family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Originally posted on Himalayas