- Negotiate medical claims with healthcare Providers.
- Send and acknowledge receipt of contracts from Providers.
- Track all Settlements.
- Correspond with clients, medical Providers, and reinsurance carriers over the phone and via email.
- Review and understand the terms and conditions of group health plans and reinsurance policies.
- Understand and comply with all applicable privacy and security laws, including HIPAA and any regulations promulgated thereto.
- Consult with other entities who can offer additional evaluation of a claim.
- Review, analyze, and add applicable notes to the Qiclink System.
- Assist and support other team members as needed and when requested.
- Attend continuing education classes as required, including HIPAA training.
- Perform other duties and special projects as requested.
EDUCATION
- Bachelor’s degree or equivalent work experience required
EXPERIENCE AND SKILLS
- 1-3 years of experience in a Call Center or Customer service role.
- Experience with medical claims preferred.
- Effective communication skills to interact with members, Providers, and insurance carrier representatives, emphasizing ability to communicate verbally and in writing.
- Assertive, self-confident, and resilient.
- Proficiency in Microsoft Word and Excel
- Ability to search and identify resources through the internet.
- Demonstrated ability to communicate concepts, strategies, and plans in terminology understood by business professionals.
- Ability to interpret Explanation of Benefits (EOBs).
- Familiarity with several types of health insurance coverage, coordination of benefits, and UCR fees.
- Highly effective time management skills