Job Description

Our Customer Service Representatives are responsible for answering the phones in a timely manner, being a skilled problem solver, have the ability to work well with others along with meeting set quality standards. Be courteous and professional while providing information to callers. Plus additional projects and assistance with mailing projects as needed.

WHAT YOU’LL BE DOING

• Assuring the accurate and timely handling of client and member calls with total follow through
• Providing excellent customer service
• Answering client and provider questions including, but not limited to claims payment, status and coverage information
• Interpreting client health plan protocol
• Backup to the claims processing area by assisting with reports and workflow queues as assigned
• Check tracer documentation
• Maintaining accurate and complete call documentation
• Maintaining high level of professionalism
• Returning incoming calls
• Other duties as assigned

Qualifications

WHAT YOU'LL NEED TO HAVE

• Bilingual (English/Spanish) required
• Minimum of 2 years experience in a high volume healthcare call center required
• Knowledge of healthcare claims review or processing required.
• Health Care/Health insurance background required.
• Experience with BCBS HMOI or other insurance plans a plus
• Use of multiple systems including Teams and Excel, Jira is a plus
• Excellent verbal and written communication skills
• Must be available for an 8 hour shift between 8am to 6pm Central time.

WHAT WE WOULD LOVE FOR YOU TO HAVE

• HMO Managed care Medicare Advantage experience.

Additional Information

_ The base pay range for this role is between_ $ 19.00 to $20.00 per hour, paid bi-weekly

BENEFITS:

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.