PacificSource Health Plans
Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.
Work efficiently in a high volume call center while maintaining a professional, polite manner.
Assist callers with coverage related questions; accurately interpret policy provisions for group and individual business.
Analyze customer\u2019s inquiries and determine steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and organized.
Document calls in a clear and consistent manner in computer system.
Conduct appropriate research and follow-up for prompt resolution of disputed claims.
Relay information to appropriate departments and personnel using established communication channels and procedures.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: One year medical insurance, other healthcare related field or call center experience required.
Education, Certificates, Licenses: High School Diploma or equivalent required.
Knowledge: Understand insurance and medical terminology, coding and standard medical billing practices. Proficient computer skills, typing, and 10-key required. Medical terminology, CPT/ICD-9 coding preferred.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customer's experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internal and external.
We encourage creativity, innovation, continuous improvment and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, gender identity, age.
PacificSource Health Plans
Website : http://www.pacificsource.com
With an 83-year history and reputation for taking great care of people, PacificSource Health Plans delivers healthcare solutions to businesses and individuals throughout the Northwest. PacificSource is an independent, not-for-profit community health plan that values partnership, service excellence, community, and personal relationships. We offer employers a wide range of group medical, dental, prescription drug, and vision benefits. Learn more about our plans. We meet the needs of individuals and families with comprehensive individual health plans. Learn more about our plans. PacificSource coverage includes a wide range of no-cost extras designed to help you make the most of your health plan. Through our sister company, PacificSource Community Health Plans, we offer Medicare Advantage Plans under the name PacificSource Medicare. Through our sister company, PacificSource Community Solutions, we offer Medicaid plans. The PacificSource family of companies serves more than 275,000 individuals and 3,900 employer clients throughout the Northwest. We are based in Eugene, Oregon, with regional offices throughout Oregon, Idaho, Washington, and Montana. Learn more about our locations. Our provider network includes 46,300 participating healthcare practitioners and facilities in the Pacific Northwest. Through our subsidiaries, we provide third-party administration of self-funded employee benefit plans, flexible spending accounts, HRAs, and COBRA plans. Learn more about our subsidiary companies. Together, the PacificSource family of companies employs about 700 people in Oregon, Idaho, Washington, and Montana.