Customer Service Rep - Fully Insured

Company: Carle Health
Location: Champaign
Posted on: February 20, 2025

Job Description:

Overview

Responsible for accurately and completely answering and documenting inquiries from members, employers, employer groups and providers. Facilitates communication between self, other departments, members, providers, provider offices, employers, and brokers to ensure that needs of members are met.
Qualifications

Certifications: , Education: , Work Experience: Customer service
Responsibilities

Meets standards for documentation, answering and follow-up on all benefit, eligibility, network, and claims inquiries from Health Alliance members and providers generated by telephone, walk-in, or written correspondence.
Takes action to resolve customer service, claims, or billing complaints by partnering with other departments if and when necessary. Follows up to ensure that appropriate changes were made to resolve the source of the problem. Refers unresolved complaints to the Customer Service Complaint Resolution Specialist or advises members/providers of the right to appeal.
Educates members and providers regarding a variety of insurance topics, including, but not limited to Healthcare Reform, Exchanges, coordination of benefits and Medicare coordination.
Processes requests for member materials including, but not limited to ID Cards, federally required Summaries of Benefits and Coverage, Policies, Schedules of Benefits, Provider Directories, Explanations of Benefits, and Remittance Advices.
Assists members in accessing company websites.
Consistently meets or exceeds department specific performance and quality requirements.
Basic communication skills (Telephone Courtesy Guidelines P&P, scripting, and scores/feedback from Quality Assurance Advisor and Customer Service Lead).
Basic computer skills (all applications used by Customer Service).
Basic problem solving skills.
Follows and adheres to accountability structure and required behavioral standards.
About Us

Find it here.Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. - For more information: human.resources@carle.com.
Compensation and Benefits

The compensation range for this position is $17.12per hour - $27.73per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model.



Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

Keywords: Carle Health, Champaign , Customer Service Rep - Fully Insured, Sales , Champaign, Illinois