Claims And Enrollment Customer Service Representative Iv In Va (Remote)

Virginia Beach, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara Health is currently recruiting for a Claims and Enrollment Customer Service Rep IV . Remote in Hampton Roads and surrounding areas!

Status: Full-Time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F

Location: Remote with occasional onsite meetings when the Director is in town (approx 2-3 year). Preferred local in Hampton Roads or North Eastern NC.

Job responsibilities:

The CSR IV serves as the subject matter expert in customer operations for benefit administration, claims, pharmacy issues, group set up, enrollment, billing and broker commission issues. Follows up on member engagement surveys. Handles high level or executive escalations, identifies the cause and provides resolution. Performs routine & complex servicing of operational issues for providers, members, benefit administrators (BAs) & brokers.

Required qualifications:

• 5 years of experience in customer service, health plan claims, marketing, pharmacy tech, OR sales is required.
• HS Diploma or equivalent required

Preferred qualifications:

• Knowledgeable in claims and enrollment preferred
• Corporate experience would be a plus.
• CSR IV must have strong written and oral communication skills.
• In addition, at least 2 years or more years utilizing Microsoft Office. Proficient in Excel, Word and PowerPoint

Benefits: Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more. Sentara recognizes our employees by offering:

• Comprehensive health care plans
• Generous paid annual leave
• 401a/401k/403b plan
• Long and short-term disability
• Tuition Reimbursement
• Flex spending and life insurance
• You can expect employee recognition, performance rewards, plus countless services and programs to enhance work/life balance.

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans, and plans serving Medicare and Medicaid enrollees.

With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day, join the Sentara Team!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-70287

#Indeed

#Monster

Talroo – Health Plan

Keywords: Customer service, health plan, Managed Care, MCO, healthcare, claims, marketing, pharmacy tech, sales, high school diploma, GED, Microsoft Office, enrollment

Job Summary

Responsible for all areas of customer service as it pertains to the acquisition and/or retention of members within the health plan or customer access as it relates to patient scheduling and referral within the Access Center. Performs routine & complex servicing of operational issues for providers, members, benefit administrators (Bas), brokers, or provider practices. Serves as the subject matter expert in customer operations for benefit administration, claims, pharmacy issues, group set up, enrollment, billing, broker commission or access and referral issues if within the Access Center. Responsible for root cause analysis and trending of repeat service issues as they pertain to strategic initiatives with particular focus on easy to do business with (ETDBW) initiatives. Works with leadership to implement processes that support ETDBW initiatives.

Acts as the team leader in support of Customer Service Rep teams.

5 years’ experience in customer service, health plan claims, marketing, pharmacy tech, OR sales is required.

Qualifications:

HS – High School Grad or Equivalent (Required)

Customer Service, Health Plan Claims Disbursmnts, Marketing, Pharmacy Technician, Sales

Skills

Microsoft Access, Microsoft Excel, Microsoft Word

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.