Customer Service Representative I – Enrollment
Employment Information
Job Description
Customer Service Representative resolving enrollment and eligibility issues at Geisinger Health Plan. Providing high-level customer service and supporting peers in claims resolution.
Responsibilities:
- Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service.
- Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
- Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
- Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors.
- Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
- Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules.
- Determines the eligibility of most members as well as processing terminations and disenrollments.
- Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity.
- Determines if services received are covered benefits as applicable by line of business and product design.
- Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
- Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
- Provides daily support and advice to member and provider services staff regarding claims issues.
- Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.
Requirements:
- High School Diploma or Equivalent (GED)- (Required)
- Minimum of 1 year-Customer Service (Required)
- Skills: Communication, Customer Retentions, Customer Service
Benefits:
- healthcare benefits for full time and part time positions from day one
- vision
- dental
- benefits for domestic partners
- atmosphere of collaboration, cooperation and collegiality
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