Claims Inquiry Unit Representative

Summary

To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties.

Duties and Responsibilities:

Be proficient in discussion and execution including, but not limited to, the following:

• Multi-Task in a very busy Call Center Environment
• Explanation of how the plan works and how to utilize the service
• Explanation of the Claim process, payment, denials, etc.
• Provide Appeal Status
• Assist with Benefit clarification and eligibility with correspondence from appropriate department
• 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 Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.
• Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal.

Minimum Job Requirements:

• High school diploma. Two years of Customer Service/Call Center in related field preferred. 
• Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10, HFCA1500 Forms, UB94 Claim Forms

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 and Back Office as well as Claims/Billing experience preferred
• Bilingual in Spanish preferred

Salary Range:

• $19 - $23 hourly