Experienced Claim Representative – Full Remote Opportunity with careerzynith
At careerzynith, we're committed to delivering exceptional customer service and support to our valued clients. As a key member of our team, you'll play a vital role in ensuring seamless communication and efficient processing of claims. If you're passionate about providing top-notch service, have a knack for problem-solving, and are eager to grow your career in a dynamic environment, we invite you to join our team as an Experienced Claim Representative.
- *About careerzynith**
careerzynith is a leading provider of innovative solutions in the healthcare industry. Our mission is to empower individuals and organizations to achieve their goals through cutting-edge technology, expert knowledge, and a commitment to excellence. With a strong focus on customer satisfaction, we strive to create a positive impact on the lives of those we serve.
- *Job Summary**
As an Experienced Claim Representative, you'll be responsible for managing authorizations, notifications, and other service requests received via phone calls, faxes, and portal submissions. You'll provide exceptional customer service, handle escalated callers, and utilize your expertise to plan, accomplish goals, and effectively resolve each assigned task. If you're a motivated and detail-oriented individual with a passion for delivering outstanding results, we encourage you to apply for this exciting opportunity.
- *Key Responsibilities**
- Manage authorizations/notifications and other service requests received via incoming phone calls, faxes, and portal submissions
- Provide excellent customer service, including the ability to handle escalated callers
- Determine authorization or notification requirements
- Prepare authorization cases for Medical Directors, Network Operations Nurses, and Case Managers
- Provide administrative approvals (depending on the line of business)
- Handle expedited authorizations, authorization updates, and status checks
- Confirm member eligibility
- Outreaches to providers and/or patients to complete authorization requests and prescriptions
- Maintain knowledge of various health plan partner benefits, networks, CMS regulations, and health plan partner policies
- Utilize experience and judgment to plan, accomplish goals, and effectively resolve each assigned task
- Perform all other related duties as assigned
- *Essential Qualifications**
- High School Diploma or equivalent (verified through a reputable background check service)
- 1.5 to 2 years of claims experience
- Medical Terminology knowledge
- ICD 9/ICD 10 and CPT knowledge
- Claim experience
- Call center experience
- Proficiency with Microsoft Office Word, Excel, and Outlook
- *Preferred Qualifications**
- 2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
- Ability to work one of the varying shifts to support our 24/7 operation
- Required to have a dedicated work area established that is HIPAA compliant
- Ability to keep all company-sensitive documents secure (if applicable)
- Must live in a location that can receive approved high-speed internet connection or leverage an existing high-speed internet service
- *Skills and Competencies**
- Excellent communication and interpersonal skills
- Strong problem-solving and analytical skills
- Ability to work independently and as part of a team
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
- Strong attention to detail and organizational skills
- Ability to maintain confidentiality and handle sensitive information
- Strong customer service skills and ability to handle escalated callers
- *Career Growth Opportunities and Learning Benefits**
At careerzynith, we're committed to helping our employees grow and develop their careers. As an Experienced Claim Representative, you'll have access to:
- Ongoing training and development opportunities
- Mentorship and coaching from experienced professionals
- Opportunities for advancement and career growth
- A dynamic and supportive work environment
- Recognition and rewards for outstanding performance
- *Work Environment and Company Culture**
careerzynith is a remote-friendly company that values flexibility and work-life balance. As an Experienced Claim Representative, you'll have the opportunity to work from the comfort of your own home, with a dedicated workspace that meets our HIPAA compliance requirements. Our company culture is built on a foundation of:
- Collaboration and teamwork
- Open communication and transparency
- Respect and empathy for all employees and clients
- A commitment to excellence and continuous improvement
- *Compensation, Perks, and Benefits**
careerzynith offers a competitive compensation package, including:
- A salary range of $45,000 - $60,000 per year, depending on experience
- Opportunities for bonuses and incentives
- Comprehensive benefits package, including health, dental, and vision insurance
- 401(k) retirement plan with company match
- Paid time off and holidays
- Access to ongoing training and development opportunities
- *How to Apply**
If you're a motivated and detail-oriented individual with a passion for delivering outstanding results, we encourage you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your experience and qualifications. We can't wait to hear from you!
- *Equal Employment Opportunity**
careerzynith is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence, and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
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