Call Center Specialist

Our Medtech client is hiring a team of Call Center Specialists! This is a fully remote position with full-time hours (40 hrs/week), with Central or Eastern working hours.

This position will take a high volume of inbound calls to process a paperless health insurance subrogation caseload by investigating potential cases and pursuing med-pay, no-fault, liability, and workers' compensation recoveries. This position's work environment is team-orientated. The incumbent will coordinate efforts with other members of the subrogation team to maximize recoveries.

Job Roles And Responsibilities

• Follow client specific procedures and guidelines. Understand basic health plan contractual provisions and apply to the reimbursement efforts. Ensure compliance of state and federal laws.
• Adapt to process changes and help improve and implement new processes.
• Identify and develop subrogation opportunities.
• Research and request case information to develop cases. Access and pull benefits from clients' remote health claim systems.
• Place parties of interest on notice.
• Respond timely to all electronic, written and verbal communications. Log information derived from written and verbal communication; where required maintain detailed and accurate records. Maintain a calendar diary to monitor case activity.
• Pursue worker's compensation, first and third party, med-pay coverage and no-fault recoveries.
• Engage advice and/or help of Management to proactively resolve cases. Provide feedback to Management and unit on trends or developments.
• Maintain department productivity and quality standards.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company's Core Competencies and values held within.
• Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope

The incumbent works under general supervision while keeping the needs of external and internal customers as a priority when making decisions and taking action. The incumbent communicates across a base of clients, members, and their employers. The successful individual in this role must be open to feedback, teamwork, and show a keen interest in contributing ideas to improve existing departmental processes. Decision making in the role is limited and must fall within established guidelines and may often end up being escalated to higher levels.

JOB REQUIREMENTS (Education, Experience, And Training)

• Minimum high school diploma and one (1) year experience in an analytic or claims environment. Bachelors' degree in a relevant field is strongly preferred.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Developed customer service skills.
• Strong organizational and time management skills.
• Ability to work independently and as part of a team.
• Working knowledge of Microsoft Word, Excel, internet research skills.
• Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

Dexian (on behalf of our client) is an Equal Opportunity Employer. We recruit and hire qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.