Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Medicare Customer Service Associate
Summary: To provide telephonic customer service to members, providers and facilities.
Responsibilities:
• Receives and responds to telephone calls and correspondence from members, regarding billing, benefits, coverage, payment, coding, and health services policies and procedures.
• Maintains telephone log documenting number, content and type of calls received.
• Explains medical pre-authorization requirements and disposition of pre-authorization requests, as necessary.
• Researches and analyzes recurring billing and eligibility problems/complaints to determine root causes and trends.
• Collaborates with Management to identify areas of member/participant dissatisfaction and trends concerning membership or benefits.
• Researches and analyzes recurring member problems/complaints to determine root causes and trends; recommends solutions and/or resolutions.
• Provides instruction to members for submitting out-of-plan medical claims.
• Acts as customer advocate in providing assistance to resolve callers' issues and problems.
• May provide instruction to members for obtaining prior approval on benefits that have certain restrictions.
• Investigates requests for claims adjustments by callers and collaborates with Claims teams to ensure claims adjustments have been made. Follows thru w/callers by communicating when/if adjustments can not be made.
• Performs other related projects and duties as assigned.
Qualifications:
• Post High School education/training or equivalent combination of education and experience.
• At least 2 years of previous customer service experience in a medical office, sales/service or billing environment required; telephonic customer service experience preferred.
• Knowledge of Medicare Regulations/Product, ICD-9 and ICD-10 diagnosis, CPT-4, UB82 revenue codes, UB92 revenue coding and procedural coding desired.
• Excellent oral and written communication skills and interpersonal skills required.
• Previous system user experience in a highly automated environment required. Strong personal computer skills.
• Demonstrated analytical skills desirable.
• Excellent telephone manner; ability to handle high volume of calls efficiently and courteously.
• Ability to perform in office environment with extended periods of sitting, using telephone, viewing computer screens, standing, reaching, lifting files, binders, computer reports.
ESSENTIAL JOB REQUIREMENTS:
• Primarily sedentary
• Must be able to use standard office equipment
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.