Customer Care Representative for Benefits Call Center
Posting Date: 09/06/2017
Closing Date: Until Filled
Reports to: Team Manager
• Demonstrate the ability to communicate effectively to both Member and Provider calls when requesting claim status, benefit verification and reimbursement explanations; and can respond to other inquiries when received via online requests
• Must consistently meet performance essential job duty standards:
o Average talk time of 5.00 minutes or less
o Manned time of 6.50 hours or more
o Quality of 95% or better
o Abandonment rate of 5% or less
o Ability to log 65 calls average per day (as defined by the specific range criteria)
• Ability to communicate complex claim or unresolved issues and will refer escalated calls appropriately to immediate supervisor if necessary
• Provides assistance to the group membership as related to service associated with patient advocacy
• Returns phone calls and voicemails within 24 hours.
• Completes and documents all entry of calls accurately and timely; refers to the appropriate department and for adjustments if necessary.
• Automated fax system – responsible for transferring caller appropriately for daily interaction and reporting;
• Utilize the translation line for Spanish calls as needed
• Assist membership reset online password requests as needed
• Assist with transplant calls as needed
• Assist with administrative duties as assigned, including online Health X inquiries and provider claim status requests
• Assist with escalated calls, follow up and close down appropriately with caller
• Protects the confidentiality, integrity and availability of information and records that TML IEBP creates, receives, maintains or transmits by complying with TML IEBP policies and procedures on physical, administrative and technical safeguards.
• Understands role in organization and impact of job performance on other employees of the organization
• Displays professional demeanor and positive attitude with the Department and Organization
• Protects the confidentiality, integrity and availability of information and records that TML IEBP creates, receives, maintains or transmits by complying with TML IEBP policies and procedures, including policies and procedures on physical, administrative and technical safeguards.
Qualifications / Skills Required
• Three years of customer service, billing and processing experience in a medical claims office or related setting
• Knowledge of medical terminology and of medical/dental/vision processing principles and benefits administration. Working knowledge of MS Office and Claims Processing System (CPS)
• Knowledge of managed care contracting, ability to read, comprehend and carry out verbal or written instructions & ability to write simple correspondence.
• Ability to effectively work in a team environment and perform multi-task job functions.
• Ability to type 40 words per minute. ten key by touch and strong organizational skills: ability to effectively present information in one-on -one and small group situations to Member, Providers and Employees of the organization
• Ability to learn to adjudicate claims as back up if necessary , eoe
Please submit your resume with a cover letter to Human Resources. Indicate the position you are applying for
and detail how you meet the qualifications listed. You may fax this information to (512) 719-6717
, email us at Email Us
, or mail it
TML MultiState IEBP
Attn: Human Resources
P.O. Box 140644
Austin, TX 78714-0644