Customer Service Representative

HCA Healthcare is a healthcare organization committed to delivering respectful and compassionate care. The Customer Service Representative supports patients, members, and providers in a call center environment by answering inquiries, resolving issues related to claims and provider services, documenting contacts, and coordinating with internal departments.

Responsibilities:

• Answers member and provider telephone calls within performance standards, following departmental procedures
• Researches and responds to callers questions and concern received via telephone and mail and on-line
• Responds in writing or with appropriate telephone contact to inquiries
• Coordinates resolution of member issues with Claims department
• Coordinates resolution of provider issues with Network Management, Medical Management and Claims departments
• Logs and /or tracks caller contacts in the computer system
• Conducts member/provider satisfaction surveys as instructed
• Perform other duties as assigned
• Serves as initial point of contact for patients and providers by answering multi line phones
• Serves as an integral part of the Customer Service. It is a complex role requiring multidisciplinary collaboration
• Determines the nature of the call and assist with communicating needs regarding prior authorizations, claims and provider inquiries to the appropriate personnel
• Engaged in clinical and administrative network designed to provide fast responsive help for patients seeking care

Requirements:

• strong verbal and written communication skills, empathy, attention detailed and a good understanding of medical office operations and health insurance processes in a call center environment
• candidate must live in the San Jose, CA area
• Prior claims processing experience or strong knowledge of provider billing procedures
• Detailed oriented
• Ability to understand health plan benefit programs sufficiently to explain programs to members
• Effective written and verbal communication skills, particularly skilled in handling telephone contacts
• Research questions, identify issues and route system or procedural problems to the supervisor
• Ability to understand the computer system and be proficient in accessing history and data files on line
• Ability to work well within a team environment
• Ability to listen, speak and write effectively and efficiently at a level appropriate for the job
• Ability to exercise calmness in high volume and stressful situations and apply sound judgement
• Two-year experience in Customer Service
• One-year experience in medical terminology with ICD-10 codes and CPT codes required
• Experience with navigating websites/browsers and using chat software
• Proficient in Microsoft Office (Word, Excel, and Outlook)
• Ability to maneuver between multiple tasks