Claims Customer Service (Medical Group)

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  • 19-00186
  • Full Time/Contract
  • Claims
  • Pasadena, CA
Job Description
Claims Customer Service

Under general supervision, following established procedures, assist and direct patients and or providers in an empathetic and caring manner, efficiently and timely, and complete appropriate documentation. Respond to provider inquiries and attempt to resolve provider concerns or refer to management for resolution.

  • Comply with Customer Service policies and procedures.
  • Read all new P&P's and review others annually as needed
  • Answer incoming calls from our customers to include but not limited to: members, providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines.
  • Maintain an average handle time of no more than 10 minutes
  • Maintain our average wait time to 5 minutes or less.
  • Research and resolve claims inquiries and any additional concerns in a timely fashion.
  • Accurate documentation of calls into customer service module using appropriate wrap up codes.
  • Educate contracted providers about TAT's, Portal access and other information as needed, document provider education in customer service module
  • Retrieve and return voicemail calls from customers and respond before the end of the day in accordance with HIPAA guidelines.
  • Assists Supervisor and Manager with other duties as assigned. As well as supporting other departments when needed.
  • Member outreach communications via mail or telephone.
  • Report to Supervisor/Manager on activities and/or problems occurring throughout the day
  • Responsible to assist with the training of new employees and meet changing performance objectives as necessary.
  • Responsible to always show respect for member confidentiality and privacy, such as, not expressing opinions about members that can be overheard by others.


  • High School Graduate or equivalent
  • A minimum of one-year Healthcare related experience in managed care environment to include but not limited to an IPA or MSO preferred
  • Current knowledge of Managed Care UM and Claims procedures
  • Knowledge of medical terminology, RVS, CPT, HPCS, ICD-10 codes
  • Proficient with Microsoft applications' and EZCAP
  • Good organizational skills
  • Good verbal and written communication skills
  • Must have the ability to multitask and problem solve in a fast pace work environment


  • $15.00/hr – $17.00/hr
    (Commensurate with Experience)

Additional Information

  • Full Time, M-F
  • 8:00 AM – 5:00 PM


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