CSR II - OPE000OK
DESCRIPTION/RESPONSIBILITIES:
Analyzes, evaluates, resolves and responds to customer/provider inquiries received via telephone, correspondence or in person involving a variety of claim/benefit issues under various product lines. Will direct the adjudication of claims/inquiries.
Conducts internal and external research to determine and request the data needed to handle inquiries from Subscribers, Beneficiaries, Accounts or Providers. Obtains needed external data. Analyzes and services various product lines in the area (i.e., Administrative, Facility, Professional, Special Programs, Medicare/Complementary). Provides servicing responses by telephone, handwritten/check-off letters, or by a typewritten, self-composed letter. Initiates status reports to the inquirer when delays occur in responding to an inquiry, as required. Follows department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts). Organizes work to meet National/Corporate/Department Production and Quality Standards. Reroutes misdirected inquiries. Evaluates and price/adjudicates claims/inquiries. Interacts with others inside and outside the organization to resolve the inquiry/claim related problems. Determines the dollar amount of additional payment and directs the issuance of a check. Influences customers to accept the reasonableness of decisions and actions. May assist less experienced Reps and handle unusual or complex inquiries, including irate calls as well as those inquiries that may have implications for the retention of a group/contract, or provider. Other duties may be assigned.
VEVRAA Federal Contractor
Request Priority Protected Veteran Referrals
EOE -Veteran /Disabled/Minority/AA/F/M/SO
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, protected veteran status or status as an individual with a disability.
