Geisinger

Compensation

Full Description

Job Description: • 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