About the role
Primary Role Description
We are seeking a highly motivated and experienced individual from a medical background to join our team as a Medical Claims Call Center Representative. In this role, you will be responsible for handling inbound customer calls related to claims and the rejection of claims. Your primary focus will be to provide exceptional customer service while resolving customer inquiries and concerns effectively.
Key Roles & Responsibilities:
Answer incoming customer calls in a professional and timely manner.
Assist customers with inquiries including medical claims and rejections.
Provide accurate and detailed information about claim procedures, documentation requirements, and coverage.
Investigate and resolve customer concerns, ensuring high levels of customer satisfaction.
Collaborate with internal departments, such as claims processing to address and resolve complex issues.
Maintain thorough and up-to-date knowledge of products, medical billing codes, and claim processes.
Document customer interactions and update customer records accurately in the system.
Identify and escalate critical or unresolved issues to the appropriate department or supervisor.
Adhere to company policies, procedures, and compliance guidelines.