Senior Participant Services Specialist, Pension & Healthcare Provider

Our client is a pension and health provider serving entertainment industry professionals located in Burbank. They are considered one of the top employers in Los Angeles offering a positive and collaborative work environment and maintaining excellent employee retention.

Our client is seeking to hire an individual living locally in Los Angeles offering experience working as a "medical assistant", "front office medical" or "medical billing" from the medical terminology knowledge increasing the new hire's learning curve to develop their role in customer service and managing claims for participants in the guild.

The position is 100% remote offering a competitive salary $48k-$55k annually depending on experience, a highly professional environment, and opportunity for growth, plus an exceptional benefits package including no-cost premiums on medical, dental, and vision insurance (plus only $50 per month for up to 5 dependents); along with a full month of paid time off in your first year (with paid time off increasing with tenure); a 401k with a match plus a pension plan. The organization provides a computer and dual monitors for remote work (working from home).

CUSTOMER SERVICE

Pension & Health Provider located in Burbank is seeking to hire the right candidate providing a challenging opportunity to work in a fast-paced call center environment, as things happen quickly and continuously. You may find yourself moving from one task to another without much time in between or juggling multiple duties at the same time. The candidate must be used to operate on a daily routine that consistently has something to keep them busy. Having fast-paced environment skills will help you navigate through your job, excel at your duties and even make it an exciting place to be.

POSITION OVERVIEW:

The Senior Participant Service Specialist will process health insurance claims and answers calls from physicians, hospitals and customers. Adhere to claim and call policies and procedures while making sound claim/call decisions. Foster strong customer relationships through the resolution of customer incoming call requests. Serve our customers by determining requirements, answering inquiries, resolves problems, fulfilling requests and maintaining key performance measures. Build strong working relationships with others within the company, by demonstrating effective people skills and interpersonal savviness.

PRIMARY RESPONSIBILITIES:

Ø Meet all key performance indicators established for this position in the areas of: efficiency, accuracy, quality, productivity, system adherence, customer satisfaction and attendance

Ø Elevate and enhance the Health Funds reputation by providing “World Class Customer Service”

Ø Answer incoming phone calls from customers and identify the type of assistance the customer needs (e.g. benefit and eligibility, billing and payment inquiries, authorizations for treatment and explanation of benefits (EOBs)

Ø Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information realtime in computer systems

Ø Communicate and collaborate with customers and providers to resolve issues, using clear, simple language to ensure understanding

Ø Fulfills requests by clarifying desired information; completing call logs by entering required data in realtime; forward requests and follow through on all customer commitments

Ø Resolves problems by interpreting and clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; addressing unresolved problems

Ø Review and research incoming healthcare claims by navigating multiple computer systems and platforms and verify the data/information necessary for processing (e.g. pricing, prior authorizations, and applicable benefits)

Ø Go the extra mile to engage customers

Ø Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, federal mandates, CMS/Medicare guidelines, and benefit plan documents/certificates)

Ø Train and coach new staff

KNOWLEDGE, SKILLS, ABILITIES:

Ø Excellent customer service and telephone skills

Ø Individual must be reliable, dependable, and punctual

Ø Ability to balance and prioritize multiple tasks

Ø Ability to work in an environment with fluctuating workloads

Ø Ability to effectively balance workload in a fast-paced work environment

Ø Excellent verbal and written communication skills

Ø Ability to solve problems systematically, using sound business judgment

Ø Ability to make decisions with every call and handle escalated issues

Ø Knowledge of medical terminology

Ø Ability to research and verify claims payment issues

REQUIREMENTS:

Ø AA or BA degree preferred in related field

Ø Minimum of four (4) years of claim processing and healthcare call center environment experience

Ø Strong knowledge of benefits plans, policies and procedures

Ø Demonstrated organization and time management skills

Ø Strong phone contact handling skills and active listening

Ø Proficient with Microsoft products, including Word and Excel

Ø Proven verbal and written communication skills

Equal Opportunity Employer considering qualified candidates in accordance with state and federal laws, including those with criminal histories, in a manner consistent with the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.