Customer Service Rep II

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

This Position Is Responsible For Providing Assistance To Providers And Indian Health Services (Ihs). This Position Researches, Analyzes, And Responds To Telephone And Written Inquiries Related To Claims Issues, Pricing Issues, And Coordination Of Benefits. This Position Is Also Responsible For Resolution Of Inquiries, Including Adjustments And Making Recommendations Regarding Process Improvements. This Position Is A Subject Matter Expert In Regard To Projects And Testing. This Position Also Works Closely With The Ihs Customer And Acts As A Liaison Between The Provider And Ihs.

Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act of 1934 (title 25, USC Section 472).

Native American Indian Preference shall apply to this position pursuant to the Indian Self-Determination and Education Assistance Act (24 U.S.C. 450, et seq.), 25 CFR 271.44 and other relevant laws (title 25, U.S. code, Section 472 & 473).

JOB REQUIREMENTS:

* 1 year of experience processing medical and dental claims and accurately determining payment.

* Knowledge plan of benefits, policies, managed care processes and governing federal laws and insurance regulations.

* Ability to research claims for unbundling, duplicate charges, ineligible charges, eligibility problems, pre-existing conditions, subrogation, pre-certification, medical necessity, etc.

* Effective verbal and written communication.

* Effective interpersonal skills to relate to distressed or challenging callers capably and tactfully as well as interact cooperatively with team members.

* Strong work habits and organizational skills necessary to complete promised action on inquiries and meet team goals for speed of answer and low abandon rate, and maintain accurate records.

* Good judgment, tact and discretion needed to respond appropriately to inquiries while maintaining confidentially and professionalism.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.