Claims Customer Service Representative
Company: Integrity Marketing Group
Posted on: May 3, 2021
ABOUT INSURANCE ADMINISTRATIVE SOLUTIONS
Insurance Administrative Solutions (IAS) is a third-party
provider of comprehensive administrative solutions for our clients
in the insurance industry. We offer a business process outsourcing
solution that helps insurers optimize administrative workload,
bolster their industry expertise, leverage emerging technologies,
and streamline operations. With strong industry knowledge, we
deliver value to our customers by providing compassionate customer
service, efficient processing, and quality results. Here at IAS, we
embrace the fact that great things are only accomplished by working
as a team. We believe that all of our employees have valuable input
no matter the level. Our highly collaborative team environment
offers each of our employees a place where they can excel.
JOB SUMMARY: Examine, perform, research and
make the decisions necessary to properly adjudicate telephone and
written inquiries. Interpret contract benefits in accordance with
specific claims processing guidelines. Communicate problems
identified relevant to the claims processing system to the
appropriate people. Receive, organize and make daily use of
information regarding benefits, contract coverage, and policy
decisions. Maintain external contacts with policyholders, providers
of service, agents, attorneys and other carriers as well as
internal contacts with peers, management, and other support areas
with a positive and professional approach.
ESSENTIAL DUTIES & RESPONSIBILITIES (other
duties may be assigned as necessary):
- Interpret contract benefits accurately to policyholder, agents,
and providers with a positive and professional approach.
- Provide claim status to policyholders or providers with a
positive and professional approach.
- Send out refund request letters and follow-up as
- Produce correspondence to customers.
- Answer calls as required by company policy in a helpful,
professional, timely manner.
- Place outgoing calls as needed to provide or obtain
- Document (written/on-line) all calls while in progress.
- Transfer calls to employees in other departments as required to
meet customer needs.
- Fully document policy file or imaging system with all related
material so as to leave a clear and concise audit trail.
- Actively participate in cross training and group training
sessions to maximize team efficiency and maintain or exceed service
- Communicate openly with Supervisor, Team Lead and other team
members to ensure accurate responses and avoid duplication of
- High School Diploma or GED equivalent
- Minimum of one (1) year related experience in a fast paced call
- Experience in medical/insurance preferred.
- Experience with Medicare Supplement preferred.
IAS and Integrity Marketing Group are equal opportunity
Keywords: Integrity Marketing Group, Clearwater , Claims Customer Service Representative, Other , Clearwater, Florida
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