Claims Inquiry Unit – Call Center Representative
To serve as a liaison between IPA and its members. Ensures that all members receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current members, or their representative, providers, and other appropriate parties.
Duties and Responsibilities
- Benefit clarification, eligibility, verification, and claim status.
- Medical group/PCP provider assignments
- Explanation of how the plan works and how to utilize the services
- Assist with information regarding referral or authorization
- Request change of provider/member information
- Any complaints/grievances
- Update new member eligibility on appropriate systems
- Perform overrides for covered/authorized prescriptions as needed
- Participate as a team player by demonstrating support to peers, management, and the department’s goals
- Attend meetings and training sessions as scheduled
- Assist with training new employees as needed
- Show flexibility in meeting performance objectives consistent with IPA and department objectives
- Document all member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.
Minimum Job Requirements
- High school diploma. Two years of Customer Service/Telemarketing sales or related experience. Knowledge of Medi-Cal, Managed Care plans
Knowledge, Skills and Abilities Required
- Must be computer literate, typing 30 wpm
- Excellent telephone techniques
- Excellent interpersonal and communication skills; strong writing skills
- Medical Front Office experience preferred
- Bilingual in Spanish preferred
Working Conditions and Physical Effort
- Regular and reliable attendance is an essential function of the position.
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.