Customer service specialist h1.location_city

Job Description

Johnson Service Group (JSG) is seeking Claims Resolution Specialists - Customer Service for a Health Plan in Orange County, CA.
Work Schedule: Monday -Friday (8:00 a.m.to 5:00 p.m.)
Hourly range: $26.00 -$38.00 (DOE)

• Minimum Qualifications:
• High School diploma or equivalent PLUS 2 years of experience in claims resolution required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 1 year of call center experience with high call volumes or customer service experience required.
• 1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required.

Duties & Responsibilities:

• 80% - Claims Support
• Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or customer agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
• Follows up with providers as needed.
• 15% - Administrative Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets.
• Routes escalated calls to the appropriate departments and/or management.
• 5% - Completes other duties or projects as assigned.

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with cutomer's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.