Claims / Customer Service Representive Job in San Dimas, California Us
Arcadian was founded by a physician over 13 years ago, and we are dedicated to improving the health of our members by providing access to high quality, cost effective health care to over 70,000 members in 15 states across the country.
Arcadian’s Health Plan organization is a community-based local network, providing coordinated care to our members in small to medium-sized communities across the United States. We offer a variety of value-oriented Medicare Advantage health plans and we exercise the utmost standards of dignity, compassion, understanding and respect for our members.
Mission Statement
Arcadian is dedicated to consistently meeting or exceeding expectations of our members by providing access to high quality coordinated health care at a cost effective price.
Our Core Values
- We believe in attracting and retaining the best people since they are critical to our success in delivering flawless service to meet or exceed expectations of our members and CMS
- We hold ourselves accountable in our results as individuals and as members of the Arcadian Team
- We believe in an entrepreneurial and competitive spirit
- We apply honesty, integrity and respect in everything we do
- We embrace the richness of our diversity and remaining open to new ideas and contributions from our team
Job Summary:
To serve as a liaison between Arcadian internal employees and its Providers. Ensures that all callers receive a level of service that exceeds their expectations. Using two methods of communication (inbound and outbound calls). Respond and receive questions and problems from provider and other appropriate parties.
Qualifications:
Education:
- High School diploma or equivalent
Experience:
- Excellent telephone techniques
- Great soft skills
- Problem solving skills
- Good communication skills
- Knowledge of regulatory requirements affecting claims processing
- Minimum of two years customer service experience in a medially related field (e.g. health plan, physician office, home health department, HMO, IPA)
- Proficient in all claims types (both professional and hospital), knowledge of claims and compliance guidelines and regulations
- Proficient with computer and software programs including Microsoft Word and, Excel, 10 key, and must be able to type 30 wpm.
- Experience working with Medicare, dual eligible and SNP criteria and medical terminology
- CPT coding knowledge
- Experience with handling multiple projects and tasks
Skills:
- Ability to handle large call volumes while providing excellent customer service in a fast paced environment
- Ability to communicate effectively to many diverse types of persons, including varying cultural backgrounds, education and economic levels
- Assist with information regarding claims and authorization status
- Ability to communicate orally and written with proven ability to positively influence behavior and arrive at a “win-win” resolution
- Ability to work under pressure resulting from types of work, standards, and numerous deadlines.
- Must have accurate, ability to function independently with little direction
- Must be able to learn new processes and information quickly
- Must be able to display ability to anticipate and be responsive to management needs and exercise proper judgment
- Ability to define problems, collect data, establish facts and draw valid conclusions
Arcadian offers a competitive compensation package that includes:
· PPO or HMO Medical Health Coverage
· Dental Coverage
· Vision Service Plan (VSP)
· Basic Life Insurance/ADD
· Voluntary Life Insurance/ADD
· Short-term/Long-term Disability
· 401(k)plan
· Paid time off
· 8 National Holidays observed
· Employee Assistance Program
· Employee Referral Bonus Program
· Direct Deposit
Arcadian is an Equal Opportunity/Affirmative Action Employer; M/F/D/V.