Insurance Customer Service Specialist

Here’s what you will be doing:

• Resolves customer service issues, expedites the adjustments, and follow ups to ensure the resolution; adjudicates required claim adjustments identified through communication with members, employees, and clients
• Updates and maintains information and knowledge regarding plans and benefits administered by the Insurance Department; educates members and external customers on policies and procedures related to members’ health care program
• Interprets member eligibility and coverage through knowledge benefit plans, Purchased Referred Care programs, claims and departmental procedures needed to assist Tribal members, employees, and other clients; initiates check tracers and investigate claim payment irregularities
• Collaborates with the FCPHWC, ICW, Child Support, Economic Support, Elderly, and other FCP Departments to assist in providing Tribal members information needed to ease access to care; assists in the development and communication of resolutions, procedures, and policies to internal staff, as requested
• Identifies trends/issues that emerge in calls/correspondence, and informs Supervisor or Director
• Communicates the required information effectively via telephone, text messages, email and during in person contact.

What you need to be successful:

• High school diploma or GED
• Two (2) year degree in health related or communication field, including a course in medical terminology preferred or comparable experience
• Must have call center customer service experience in a health insurance, physician group practice or hospital setting
• Must have knowledge of medical terminology, insurance, and billing; NCCI and CMS coding standards
• Knowledge of applicable federal, state, county, and local laws, regulations, and requirements governing health care benefits
• Must have a working knowledge of employee health plans, the Indian Health Service, provider portals, the Affordable Care Act (ACA) and tribal member health programs, benefit eligibility, claims adjudication procedures needed to assist Tribal Members, employees, and clients
• Must successfully pass all applicable background checks and drug screens

Benefits you’ll love: 

• Approximately 5 weeks of paid time-off annually 
• 3 weeks of paid holidays 
• Premium free health insurance  
• Flexible spending accounts 
• Short-term disability  
• Life insurance  
• 401k with match