Call Center Customer Specialist, Medical Claims (Mon-Fri 8a-5p) at MultiPlan in Irving, Texas

Job Description:

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client's needs and tailoring innovative cost management solutions.

We are MultiPlan and we are where bright people come to shine!

Do you enjoy servicing customers? Do you thrive by problem solving? Well, come and show off your service-oriented skills as a Customer Service Specialist!

***Due to the pandemic our offices are closed therefore we are currently working from home. We plan to begin to open our Texas offices potentially in early 2021 at which time all employees will be expected to work out of the Irving office.

JOB SUMMARY: This position is responsible for research, resolution and communication of patient, client, provider and internal customer inquiries and any follow-up required thereafter.

JOB ROLES AND RESPONSIBILITIES:

1. Investigate, analyze, research, and resolve claim inquiries as a result of issues related to discounts, payments and balance billing.

2. Provide resolution and closure to the applicable recipients. Create and execute business correspondence to clients or providers using multiple media formats.

3. Defend and uphold discounts that providers have previously accepted to prevent balance billing or reversals, including re-education.

4. Ensure investigative notes related to any contact with providers and clients are documented and accessible throughout the applicable systems.

5. Adhere to client turn around requirements as it relates to response time and required actions.

6. Ensure the maintenance and compliance with department standards for production, accuracy, and turnaround time.

7. Perform system claim adjustments based on outcomes and communicate with client regarding confirmation.

8. Serve as liaison between Claims Specialists, Client Service Representatives, and client contacts as needed.

9. May include call center responsibilities, including adhering to call center standards.

10. Collaborate, coordinate, and communicate across disciplines and departments.

11. Ensure compliance with HIPAA regulations and requirements.

12. Demonstrate Company's Core Competencies and values held within.

13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.

JOB SCOPE:

The incumbent works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the servicing of inquiries. Work is generally complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.

* Minimum completion of high school (i.e., diploma or GED)

* Minimum 2 years experience in the healthcare industry or customer service, preferably with out-of-network claims

* Required licensures, professional certifications, and/or Board certifications as applicable

* Bilingual English/Spanish may be required of some positions

* Knowledge of health care claims and health insurance industry,

* Knowledge of insurance company and medical service provider vocabulary desirable

* Knowledge of claims processing and appeals procedures

* Communication (written, verbal and listening) problem solving, interpersonal organization, time management and decision-making skills.

* Ability to create and compose business correspondence

* Ability to multitask while setting priorities

* Ability to handle high pressure situations and variance in workload volume

* Ability to work independently as well as part of a team

* Ability to use software, hardware and peripherals related to job responsibilities including MS Office

* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Benefits of working at MultiPlan

At MultiPlan, you will be part of an organization with a proud 40-year legacy of experience and growth. We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

- Medical, dental and vision insurance

- Life insurance

- Optional and dependent life insurance

- Short- and long-term disability

- 401(k)

- Paid time off

- Paid company holidays

- Tuition reimbursement

- Flexible Spending Account

- Employee Assistance Program

- Summer Hours: Memorial Day - Labor Day we get off 2 hours early on Fridays (paid)

As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law..

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