PSA - Customer Service Representative
Company: PacificSource Health Plans
Posted on: August 15, 2019
Provide excellent customer service primarily by telephone to all
PSA customers, members and group administrators. Assist with
coverage-related questions by analyzing customer inquiries and
determining steps for resolution. Primary job function is to answer
telephone inquiries, but additional duties include assisting
walk-in customers, sorting and responding to inquiries received by
mail/email in a professional manner, processing claims, posting
refunds, auditing accounts, completing stop payments, and assisting
in other areas as needed.
- Provide excellent customer service. Expectations include
demonstrating the following: high level of customer focus,
effective listening, problem ownership, an aptitude for learning,
attention to detail, productivity and efficiency with subsequent
follow up, reliability and conscientiousness.
- Accurately process claims by researching benefits and claims
policy and procedures. Research includes, but is not limited
- Reading and understanding all related account and claim
- Comparing procedures to diagnostic codes
- Determine eligibility based on service date and plan
- Accurately enter claims to prevent duplicate reimbursements or
- Review claims for inconsistencies between billed and election
- Adjudicating point of sale transactions
- Exhibit energy and enthusiasm while assisting members and group
administrators with coverage-related questions. Accurately
interpret benefit and group plan documents for groups.
- Analyze customer inquiries and determine steps for resolution.
Research member files, regulatory guidelines, policy and procedure
documentation, and/or personnel to determine that information
quoted to callers is correct and claims have been processed
accurately. Follow through to assure all concerns are addressed and
errors are corrected.
- Communicate and document information in a professional, clear,
consistent, and accurate format.
- Relay information to appropriate departments and personnel
using established communication channels and procedures.
- Complete appropriate research and follow-up for prompt
resolution of disputed claims.
- Prepare written correspondence using system generated reports
and word-processing system. Prepare reports using spreadsheet
software. Supporting Responsibilities:
regulations concerning confidentiality and security of protected
- Follow department and company-wide policies and
- Meet department and company performance and attendance
- Participate in departmental meetings, training, and takes
advantage of opportunities to increase knowledge and skills.
- Perform other duties as assigned.Work Experience: A minimum of
1 year prior phone Customer Service experience. Experience in
medical/dental insurance or other healthcare related field
preferred. Education, Certificates, Licenses: Requires high school
diploma or GED. Knowledge: Working knowledge in the areas of
medical terminology and medical coding. Goes "above and beyond" to
assist callers by making their satisfaction a high priority.
Ability to navigate through multiple software systems while talking
on the phone. Advanced PC skills, ability to type using a standard
keyboard and operate a 10-key pad accurately. Ability to work under
time pressures and deal with emotional customers. Understand the
importance of courtesy to internal and external customers.
Competencies Our Values
- Building Customer Loyalty
- Building Strategic Work Relationships
- Continuous Improvement
- Building Trust
- Work Standards
- Contributing to Team Success
- Planning and Organizing
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for our customers' experience.
- We practice open communication at all levels of the company to
foster individual, team and company growth.
- We actively participate in efforts to improve our many
communities-internal and external.
- We encourage creativity, innovation, continuous improvement,
and the pursuit of excellence. Environment: Work inside in a
general office setting with ergonomically configured equipment.
Travel is required approximately less than 2% of the time. Physical
Requirements: Stoop and bend. Sit and/or stand for extended periods
of time while performing core job functions. Repetitive motions to
include typing, sorting and filing. Light lifting and carrying of
files and business materials. Ability to read and comprehend both
written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and
level of work performed by employees within this position and is
subject to change. It is not designed to contain or be interpreted
as a comprehensive list of all duties, responsibilities, and
qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times. PacificSource is an equal
opportunity employer.--- All qualified applicants will receive
consideration for employment without regard to status as a
protected veteran or a qualified individual with a disability, or
other protected status, such as race, religion, color, national
origin, sex, sexual orientation, gender identity or age.
Keywords: PacificSource Health Plans, Springfield , PSA - Customer Service Representative, Sales , Springfield, Oregon
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