Job Description

POSITION TITLE: Claims Customer Service Representative

SCHEDULE: Monday-Friday 8:00AM-4:30PM

LOCATION: Wexford Health Sources Inc. Corporate office located at Foster Plaza in Green Tree - (Pittsburgh, PA)

**This is an onsite position 

REQUIREMENTS:

• Experience processing claims - medical field preferred
• Customer service experience

POSITION SUMMARY

Provides customer service support and processes medical claims in a manner that ensures effective and efficient department operations. 

POSITION ADVANTAGES:

• Experience working in unique field of healthcare
• Free, convenient parking lot
• Enjoy regular well-attended employee-engagement activities with other members of corporate office 
• Annual performance reviews with raise

DUTIES AND RESPONSIBILITIES

• Answers incoming customer service calls from providers and facilitates the handling of requests for information and assistance.
• Efficiently and effectively responds to incoming claims calls and inquiries; routes calls to other staff members as appropriate.
• Process paper claims including complex HCFA 1500, UB04 and any successor forms.
• Examine and research information including authorizations, payments, denials, and resolve outstanding issues to meet client and provider expectations.
• Resolve simple issues and, through established work processes, forward complex issues as appropriate to other members of the claims and provider contracting departments.
• Identify and communicate opportunities for process improvement to management and co-workers.
• Educates providers on Wexford Health and appropriate contacts within the company for claims inquiries, utilization management, contract status, and other questions that may arise.
• Maintains logs and keys information into database(s) as necessary for data collection and tracking purposes.

BENEFITS:

• Annual review with performance increase
• Generous paid-time off program that combines vacation and sick leave
• Paid holidays
• Comprehensive health insurance through Blue Cross Blue Shield
• Dental and Vision insurance
• 401(k) retirement saving plans
• Company-paid short-term disability
• Healthcare and dependent care spending account

Minimum Qualifications:

• High school diploma or equivalent.
• 2+ years customer service and medical claims processing experience.

Required Skills:

• Service orientation: ability and willingness to calmly and effectively assist customers and represent Wexford Health in a professional manner at all times.
• Previous health care related customer service experience with health care products and/or medical terminology.
• Ability to follow general directions and make adjustments to fit specific situations as needed.
• Initiative:  takes appropriate action in the pursuit of individual, group, and organizational objectives, before being asked by others or forced by circumstances.
• Must be a team player.
• Strong attention to detail.
• Approaches changes in a positive manner.
• Excellent oral and written communication skills; excellent interpersonal skills
• Proficiency in Microsoft Word, Power Point, Excel and Microsoft Access database entry
• Experience with Office Equipment (fax, copier, computers, postage machine, folder)