Indianapolis, Indiana
Client Relations Specialist-Health Insurance Job Opening in Indianapolis, Indiana - Point Comfort Underwriters, Inc. (PCU) is a fast-growing international healthcare administration and medical insurance underwriter. Founded by veterans of the international insurance and financial services industry in March 2014, PCU provides insurance plans, healthcare access and claims management services to thousands of non-US citizens living in the US, and US citizens overseas in over 120 countries.
This position is full-time (40 hours/week) Monday ? Friday
Qualified Candidates must comply with the following requirements:
Submit full resume including a cover letter and three work related references
Primary Responsibilities:
Answer incoming phone calls and emails from healthcare customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment, explanations of benefits (EOBs) and travel insurance purchases/issues)
Review and research healthcare claim inquiries presented by the member, shelter, or provider, and provide detailed instructions on follow-up steps
Review and research incoming healthcare claims from members and providers (providers, clinics, etc.) by navigating multiple computer systems and platforms, and verify the information necessary for processing (e.g. pricing, prior authorizations, applicable benefits, etc.)
Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (i.e. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare pricing guidelines, benefit plan )
Participate in provider recruitment as directed by management
Build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers
Educate providers regarding policies and procedures related to referrals and claims submission; web site education, EDI and problem solving
Communicate and collaborate with members and providers to resolve issues using clear, simple language to ensure mutual understanding
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance
Qualifications:
A combination of at least 5 years of combination of education (in a related field) and work experience (in a related field).
An education level of at least a high school diploma or GED is required
Familiarity with Mac and PC computer applications, including the ability to learn new and complex computer system applications
Ability to multi-task, as well as the ability to understand and communicate details regarding multiple products and levels of benefits within each product
Excellent typing skills and working knowledge of Mac, PC and MS Office applications required
Knowledge of claims processing, medical and healthcare terminology a real plus
21 years of age or older.
Valid driver's license, and reliable transportation to work.
Good driving history. No DUI, OWI, reckless driving or other major driving infractions
No felony convictions, drug or weapons violations. No elevated misdemeanor violations.
Candidates must successfully complete a 10-year FBI background check.
Candidates must successfully complete a 10-year pre-employment background check.
Candidates must submit to pre-employment drug screening, and SDI anti-drug program.
Ability to work with little or no supervision.
Positive personality traits and a customer service oriented attitude
Job Type: Full-time
Salary: $14.00 /hour
Job Location:
Indianapolis, IN
Required education:
Associate
Required experience:
related: 3 years
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