Healthcare Customer Service Rep - (New Mexico)

Ready to make a difference? Apply now and be part of Team ImagenetLLC!

About the Role:

Join our team as a Healthcare Customer Service Rep II, where you will play a crucial role in taking member services calls in relation to policy management, benefits and claim inquiries. You will be a valued member of the team, providing exceptional customer service to our clients and members by ensuring their satisfaction on calls. As a key contributor, you will be responsible for accurately and efficiently reading and relaying information to members.

This position requires a solid understanding of the healthcare medical claims, benefits and policy process flows and expertise in healthcare terminology, including ICD-9 and ICD-10 coding.

Job Type: Full-time - 100% Remote Position

Schedule: Monday -Friday 9:00am to 9:00pm EST/8:00am to 8:00pm CT (shifting schedule)

Pay: $17.00 - $19.00 per hour DOE

What We Offer:

• Paid training period
• Medical, Dental, Life, Vision, HSA, 401K
• Paid Holidays
• PTO
• Equipment provided

You will be responsible for:

Policy Management

• Billing: Process member payments, address billing inquiries, and resolve billing discrepancies.
• Member Information Updates: Update member information accurately and promptly, including addresses, phone numbers, beneficiaries, and employment details.
• Policy Terminations and Reinstatements: Handle policy termination requests, process policy terminations effectively, and assist with policy reinstatements.
• ID Card Ordering: Process ID card orders efficiently, ensure timely delivery, and address any ID card-related concerns.

Benefits

• Coverage Information: Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions.
• Prior Authorization and Referrals: Assist members with prior authorization and referral processes, guiding them through the procedures and requirements.
• Healthcare Provider Contact Research: Conduct thorough research to locate contact information for healthcare providers, ensuring accurate and up-to-date information for members.

Claims

• Claims Status Updates: Provide accurate and timely status updates on claims, explaining the processing stages and addressing any concerns.
• Claims Inquiries: Answer questions about claim processing, explaining claim denials, and providing guidance on submitting appeals.
• Claims Reconsideration Requests: Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.

General Inquiry

• Website Troubleshooting: Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems.
• General Questions: Answer general questions about health insurance plans, providing comprehensive and accurate information on various topics.

Additional Responsibilities

• Maintain Confidentiality: Adhere strictly to confidentiality policies and safeguard sensitive member information.
• Escalate Complex Issues: Escalate complex issues to supervisors or managers for further assistance and resolution.
• Continuous Learning: Stay updated on changes in health insurance regulations, policies, and procedures.
• Contribute to Team Success: Collaborate effectively with team members to achieve shared goals and maintain a positive work environment.

Preferred Experience:

• Comprehensive knowledge of healthcare industry practices, including:
  • Medical terminology
  • Eligibility and benefits verification
  • Medical claims processing
  • ICD-9 and ICD-10 coding
  • Policy and procedural workflows
    
• Proficient in computer operations, including data entry, screen navigation, and keyboarding
• Demonstrated excellence in customer service and client interaction
• Strong adherence to daily schedules, tasks, and performance metrics
• Ability to multitask effectively while maintaining high attention to detail
• Self-motivated, well-organized, and skilled in time management and problem-solving
• Capable of working independently and collaboratively within a team environment

Requirements:

• High School Diploma or GED required
• Excellent verbal communication skills
• Minimum of 2 yrs experience in one or more of the following areas:
  • Claims examination
  • Health Insurance
  • Customer Service or Call Center
  • Medical office or other healthcare-related fields

• Proven experience in customer service related to claims processing, billing, or similar functions
• Must successfully pass a criminal background check

***WORK FROM HOME REQUIREMENTS***

• High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide a speed test.
• Ability to directly hardwire to your modem
• Required to have a quiet dedicated work area.

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.