Job Description

Abacus Solutions Group is currently seeking a Call Center Representative for a large healthcare system, based out of Allentown, PA. This is a long-term contract position. 

JOB SUMMARY: Supports a positive service experience while handling member and provider inquiries via telephone, Customer Service portal, or written correspondence.

• Fluency in Spanish (STRONGLY PREFERRED)
• High School Diploma/GED
• 2 years Call center experience
• 2 years Insurance and/or claims administration experience
• Ability to take the initiative to identify and carry out responsibilities to their completion.
• High degree of professional judgement and inter-personal skills at all levels and among all disciplines.
• Banking background and credit background, analytic and customer services skillset will be successful.

JOB FUNCTIONS:

• Handles 80 - 100 calls per day per rep.
• Performs ancillary customer service functions relative to claims, providers, recoveries, and forms or letter generations.
• Uses multiple systems and screens to efficiently handle interaction.
• Offers solutions that aid and facilitate a unique customer service experience, including First Call Resolution (FCR).
• Anticipates needs; educates members and providers about related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
• Engages caller to gather necessary information to guide through plan of benefits, answer questions regarding care needs, and resolve issues.
• Interacts with customers, vendors, and colleagues professionally to ensure questions are answered accurately and in a timely manner.
• Assists with billing questions, claim adjustments, FSA/HSA account, COBRA payments, etc.
• Handles requests related to appeals and pre-authorizations.
• Meets all quality and adherence standards.
• Participates in team and individual discussions related to process improvement.
• Knowledge of insurance or claims administration.

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