Healthcare Customer Service Representative
(Full Time, Permanent Opportunity)
We are expanding and seeking am experienced Healthcare Customer
Service Representative to join our Team.
We are currently working on a remote basis, however, we will
eventually progress to a hybrid setting once Covid eases.
We will provide Training for this role remotely and on-site.
This is a full time, permanent, role working Monday-Friday between
the hours of 8:00 am - 6:00 pm, dependent on which shift you’d be
working. We are located in Lyndhurst, NJ.
We offer a great work/life culture along with a competitive salary
and full benefits.
We excel at providing services for employee benefits plans. Since
1983, we have provided claims processing, brokerage and administrative
services for employee benefit programs to Plan Sponsors, Welfare
Funds, Associations, and Employers as if we were a department in the
We provide plan management and offer a professional staff of employee
benefit administrators to assist our clients’ who are working within
Human Resources, Personnel Departments, and Welfare Plan
Administration in providing the finest, most cost effective and
employee satisfying benefit programs.
We have helped our clients save millions of dollars in costs on their
Group Health and Employee Benefit programs.
We are looking for a skilled problem solver to join our team as a
Customer Service Representative. We need an enthusiastic individual
who can listen to customer service issues and then offer a unique and
innovative solution to each problem.
The successful candidate for this role will have a strong command of
the company’s customer service policies and be well-trained in
eligibility benefits and claims knowledge to be able to offer quick
and accurate assistance to customers.
* Manage incoming calls and customer service inquiries from members,
doctors, hospitals, and other professionals via telephone regarding
eligibility for health benefits and claims processing
* Maintain HIPAA compliance while communicating with members via
telephone or written correspondence regarding benefit eligibility and
* Distinguish the benefit plans per member, per client (or group) and
identify their appropriate enrollment and eligibility rules and
required documentation; communicate to management team system
discrepancies for immediate resolution
* Determines level of reimbursement based on established criteria,
provider contract or plan provisions and convey the information to the callers.
* Identify dual coverage, potential third-party liability cases, and
reinsurance/stop loss cases and requests additional information, when necessary.
* Create call tracking records in Call Tracking system to the
appropriate call tracking folders for resolution
* Generate correspondence to request necessary information to
complete claims payment and appropriate letters for denied claims
* Coordinates workflow with clerical support and other staff members
* Perform additional duties and projects as assigned by management