Ultimate Staffing ยท 1 day ago
Sr. Call Center Claims Rep
Los Angeles County, CA
Full-time
Onsite
Mid, Senior Level
$58K/yr - $65K/yr
4+ years expUltimate Staffing is an established organization seeking a Senior Participant Service Specialist in the greater Burbank, CA area. This customer-facing role involves processing health insurance claims and handling inquiries from various stakeholders while ensuring compliance with relevant policies and fostering strong relationships through effective issue resolution.
EmploymentHuman ResourcesManufacturingStaffing Agency
Hiring Manager
Ashly Rodriguez
Responsibilities
Deliver exceptional service by meeting established performance metrics in efficiency, accuracy, quality, productivity, system compliance, customer satisfaction, and attendance
Represent the organization with professionalism and elevate its reputation by providing world-class customer service
Respond to incoming calls and accurately identify customer needs, including benefit eligibility, billing inquiries, payment issues, treatment authorizations, and explanation of benefits (EOBs)
Actively listen, ask clarifying questions, and document information in real time
Communicate clearly and collaborate with customers to resolve issues, ensuring understanding through simple and concise language
Fulfill requests by clarifying information, forwarding inquiries, and following through on commitments
Investigate and resolve problems by interpreting issues, researching solutions, and implementing corrective actions
Review and process healthcare claims by navigating multiple systems, verifying data, and applying appropriate pricing, authorizations, and benefits
Ensure compliance with claims processing policies, grievance procedures, federal mandates, CMS/Medicare guidelines, and benefit plan documents
Go above and beyond to engage and support customers
Train and mentor new team members as needed
Analyze existing business procedures to identify gaps or inconsistencies; prepare updated documentation, flowcharts, and process guidelines
Assess workflows and recommend improvements to enhance efficiency and customer experience
Evaluate and prepare for changes in software applications or regulatory requirements impacting business processes
Conduct research on benefit trends, service enhancements, and their impact on the organization
Identify internal control weaknesses and propose corrective measures
Maintain a comprehensive library of policies and procedures, ensuring accuracy and currency
Collaborate with the team to improve business process flow and resolve customer issues effectively
Qualification
Required
Bachelor's Degree
Minimum of four (4) years of claims processing preferred and four (4) years in heavy call center required
Learn various software applications and become self-sufficient in using the software in a user interface environment
Quickly learn and apply new tools, processes, and standards
Demonstrate adaptability and forward-thinking in the face of technological or organizational change
Strong analytical and interpersonal skills
Proficient with Microsoft products, including Word, Excel and Outlook
Excellent customer service and telephone skills
Individual must be reliable, dependable, and punctual
Ability to balance and prioritize multiple tasks
Ability to work in an environment with fluctuating workloads
Ability to effectively balance workload in a fast-paced work environment
Excellent verbal and written communication skills
Ability to make decisions with every call and handle escalated issues
Knowledge of medical terminology
Ability to research and verify claims payment, benefits, and eligibility issues
Strong knowledge of benefits plans, policies and procedures
Company
Ultimate Staffing
Ultimate Staffing specializes in clerical, administrative, customer service, and manufacturing and production positions.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Lisa Marez
Partnership Director
Company data provided by crunchbase