Job Description

Customer Care Associate 

Location: Remote after successful completion of training. Training is held at 4110 George Rd Tampa, Florida.

Hours: must be flexible to work any shift during hours of operation from 10a ET to 8p ET

Compensation: $17 per hour, $19 per hour bilingual Spanish

Position Summary: 

The Customer Care Associate serves as the initial point of contact for our valued customers. In this pivotal role, you will be responsible for providing an exceptional customer experience by actively listening, assessing customer needs and concerns, and delivering effective solutions that ensure a high level of customer satisfaction. This includes providing comprehensive customer support, addressing inquiries and resolving issues with professionalism and efficiency. You will play a crucial role in fostering positive customer relationships as well as ensuring every customer feels valued and supported.

Additional Job Duties:

• Ensure adherence to established claims processing guidelines, benefit structures, system protocols, and carrier requirements during claims adjudication.
• Proactively identify and escalate problem claims to the relevant internal departments or external stakeholders, including insurers, providers, and agents, and diligently follow up to achieve prompt resolution.
• Serve as a primary point of contact for incoming calls, demonstrating exceptional customer service skills and professionalism.
• Follow client and plan claims processing guidelines, benefit structures, claims processing system procedures and carrier guidelines.
• Maintain comprehensive and accurate documentation within the claims system for all processing activities and outcomes.
• Maintain a high level of productivity and accuracy to consistently achieve or surpass quality and production benchmarks.
• Expedites escalations to appropriate department and performs routine follow-up until resolved. May include some follow-up to insurers, providers and agents.
• Analyzing claim payment and explaining this to callers needing assistance with understanding their benefits.
• Document required information into the appropriate documentation systems

Requirements:

• HS Diploma or GED
• Prior customer service experience
• Must have analytical/problem solving capabilities

Preferences:

• Prior health care experience
• Knowledge of Medical terminology, CPT codes and ICD 10 diagnosis codes