Employer: VillageMD
Why VillageMD?
At VillageMD, we’re looking for a Claims Customer Service Representative help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we’ve partnered with many of today’s best primary care physicians. We’re equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.
We’re creating care that’s more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we’re looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.
Could this be you?
As a Claims Customer Service Representative on our team, your responsibilities will be to respond and resolve the most complex inquiries and questions for health care providers and members insurance claims. These will be related to medical care and benefits information, and direct members to the proper resources for further assistance with their issues. Researches and assists project team with resolution of provider claims inquires all lines of business.
How you can make a difference
- Furnish members and health care provider with details regarding benefits and claims processing
- Advise members of outstanding co-payments and coinsurance
- Log, track, resolve and respond to all assigned inquires and complaints while meeting all regulatory, CMS and corporate guidelines in which special care is required to protect and enhance VMD’s reputation
- Research escalated issues and take appropriate action to resolve them within established service level agreements, VillageMD best practice, and quality standards
- Apply a comprehensive knowledge of claims and provider contracts to completion of assignments
- Strive to achieve first call resolution and maintain the quality of the call center
- Investigate claims data to identify overpaid/incorrectly paid claims
Skills for success
- A bias for action and pragmatic solutions
- Ability to work quickly with great attention to detail
- Technical claims handling experience
- Knowledge of all products and all types of claims
- Computer literate with an above-average typing speed
- Demonstrate superb verbal and written communication skills
- Ability to work in a fast-paced environment with changing priorities
- Ability to work within tight timeframes and meet strict deadlines
- Ability to exercise sound judgment
- Prior experience as a Customer Service Specialist or equivalent, ideally within a similar setting
- Ability to resolve conflict and diffuse tensions
- A low ego and humility; an ability to gain trust through strong communication and doing what you say you will do
Experience to drive change
- High School Diploma or GED required
- 2+ years of experience in claims payment, adjudication, adjustments, or explanations/ researching and resolving claims payment issues and questions
- 2+ years of experience in a call center or customer service environment / researching and resolving operational issues
- 3+ years of knowledge and experience in claims processing and Medicare rules of regulation
- Experience in a remote (work-from-home) environment preferred
How you will thrive
In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.
Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.
Our unique VillageMD culture how inclusion and diversity make the difference
At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare.We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system.Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
For Colorado Residents only: The base compensation range for this role is $20.65 to $26.64. At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc. This role may be eligible for annual/quarterly bonus incentives (if applicable), and the selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan with company match.
Explore your future with VillageMD today.