Lead Customer Service Representative-Healthcare/Managed Care

Location: Tucson, AZ
Date Posted: 11-19-2017
Job description
Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner. Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments. Coordinate the day-to-day work functions, acting as a “go to” person and investigating and resolving complex issues.  Initiate change requests to resolve system configuration questions impacting claims processing; review and test results.  Conduct appropriate auditing processes.  Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters.  Educate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing procedures.  Provide first call resolution and “own the process” by working with appropriate internal/external resources and ensure the closure of all inquiries.  Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application.  Identify trends related to member and/or provider inquiries to respond proactively and provide feedback to management.  Collaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around times
 
Qualifications:
Education/Experience: High school diploma or equivalent. Associate’s degree and claims processing, billing and/or coding experience preferred. 2+ years of experience in Medicare, Medicaid managed care or insurance environment preferred. 4+ years of customer service experience in a call center environment. Knowledge of managed care software systems (i.e.: CRM, Amisys, TruCare, etc.) preferred. Depending on the state, bi-lingual may be preferred.
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
"Bringing Talent to the Marketplace"

KP Recruiting Group is a well established and very respected recruiting firm.  We have built a strong reputation as a premier resource for providing highly qualified candidates for our clients.  We are very experienced in many industries and have a wide range of clients.  We will serve as your advocate during your career search!  Let us do the work for you!  There is never a fee for our services!



 
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