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The Health Plan (THP) · 1 week ago

Employer Service Representative

Wheeling, WV

Full-time

Onsite

New Grad, Entry Level

The Health Plan (THP) is seeking an Employer Service Representative (ESR) to join their Customer Service Department. The ESR will handle complex and escalated inquiries from both internal and external customers, building rapport and resolving issues related to claims, benefits, and member experience.

Health CareInsuranceNon ProfitWellness

Responsibilities

Answer all calls and written correspondence in a timely, professional and friendly manner

Communicates with clients, members and providers as necessary to obtain information to resolve issues

Communicate with self-funded networks to research claim procesing errors, process network settlements and process pre-service agreements

Works with claims team and core customer service team to manually enter claims in network portals and request written correspondence to process claims

Records and tracks all information clearly and accurately

Understands benefits, eligibility, copay, coinsurance and deductibles in order to relay this information clearly and accurately

Understands claim detail, identifies claims issues and reports issues to the Manager when necessary

Keep all member protected health information (PHI) confidential

Qualification

Microsoft OfficeMedical TerminologyCPTICD codingProblem solvingWritten communicationDetail orientedSelf-starterTeam collaborationAdaptabilityConfidentiality

Required

High School graduate or equivalent

Proficient use of a computer

Written correspondence etiquette

Self-starter and works independently

Detail oriented with excellent problem solving skills

Ability to prioritize and meet deadlines

Maintains confidentiality

Superb oral and written communication skills

Proficient in Microsoft Office products (Word, Excel, Power Point and Office)

Easily adapts to changes in work requirements

Can work easily with others and collaborate with team members

Preferred

Bachelor's degree from an accredited college or university

Previous experience in working with health insurance

Medical Terminology

Knowledge of CPT and ICD-9/ICD-10 coding

Knowledge of medical and hospital claims

Company

The Health Plan (THP)

The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members.

Founded in 1979