Job Info

Claims Intermediary I

TheClaim Intermediary receives, researches, and processes transportation servicerequests and all the required billing associated with a reservation whileserving as a point of contact between new and existing transportation providersand members to answer questions and resolve any claims/billing related issues. Inaddition, the Claim Intermediary is required to identify and monitorutilization and billing trends that may signal abusive practices. The ClaimIntermediary will leverage internal and external resources as well asoutreaching to members, facilities, clients and other parties to accuratelyfulfill reservations. Performs other administrative duties as requested. Thisjob involves heavy computer usage and public telephone contact. 

Entry level role to the organization, however, experience is preferred in either health care or logistics. A strong background in customer service is required. Moderate level skills and proficiency required, as demonstrated from prior work history. Generally performs a high volume of inquiries about One Call's products and services by following standard scripts and procedures. Works under close supervision with little latitude for independent judgment. Consults with senior peers and team leads on non-complex issues to learn through experience. Typically requires one year or more of experience in a call center or customer service-related position in a service industry with an added preference of one year or more of experience in the health care or logistics industry. Claim Intermediary I's will typically handle one service line, while learning others, and will become knowledgeable in all products/services before moving into a level II role.  

GENERAL DUTIES & RESPONSIBILITIES:

• Serves as primary contact for coordination of reimbursement services
• Informs Transportation Providers and Members on proper claims submission procedures
• May handle high volume of member inquiries via phone, email, fax, and text message
• Identify and resolve problems with Transportation Providers and members
• Verify eligibility and covered benefits with insurers for all provider claims for non-contracted transports or for contracted transports not verified by the call center
• Check accuracy of charges submitted for payment including fee schedule type, diagnosis, mileage, supplies and appropriate level of service
• Provide an excellent member experience through product knowledge, superior customer service skills and demonstrated empathy for member's needs
• Identify provider claims that should be questioned for Coordination of Benefits
• Provide outreach regarding members, transportation, and other subjects as needed to medical facilities
  

EDUCATIONAL REQUIREMENTS:

• High school diploma or GED is required for this role. Associate or Bachelor's degree, especially in Finance or Accounting is preferable; or the equivalent combination of education, training, and work experience

POSITION REQUIREMENTS:

• If working with federal government contract clients, an employee is required to receive federal government clearance for handling sensitive information. Employee is also required to receive annual security awareness training

GENERAL KNOWLEDGE, SKILLS & ABILITIES:

• Knowledge and/or experience in a managed care environment interacting with health plan members 
• Knowledge and/or experience with transportation services 
• Excellent customer service skills that build high levels of customer satisfaction
• Excellent verbal and written communication skills
• Computer navigation and operation skills
• Demonstrates effective people skills and sensitivities when dealing with others
• Ability to work both independently and in a team environment

EEO Employer

841 Prudential Dr, Suite 204
Jacksonville, FL, 32207
United States