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Geisinger · 10 hours ago

Customer Service Representative I, Geisinger Health Plan (Pennsylvania resident)

Danville, PA

Full-time

Onsite

Entry Level

1+ years exp

Geisinger is a healthcare organization dedicated to caring for patients, members, and communities. They are seeking a Customer Service Representative I who will assist in resolving customer concerns and maintaining customer satisfaction by providing high-level customer service in functions such as enrollment, claims, or phones.

Health CareHospitalMedical

Responsibilities

Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines

Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups

Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors

Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments

Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules

Determines the eligibility of most members as well as processing terminations and disenrollments

Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity

Determines if services received are covered benefits as applicable by line of business and product design

Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products

Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers

Provides daily support and advice to member and provider services staff regarding claims issues

Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment

Qualification

Customer ServiceClaims ProcessingEnrollment ManagementTeam BuildingCommunication Skills

Required

High School Diploma or Equivalent (GED)

Minimum of 1 year-Customer Service

Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.

Company

Geisinger

Glassdoor3.5

Geisinger is a health and wellness organization that offers orthopaedic, weight-management, and heart care services. It is a sub-organization of Risant Health.

Founded in 1915

Danville, Pennsylvania, USA

10001+ employees