Since enrolling its first member in July of 2004, it has grown to over 26,000 members and continues to grow and expand both at its St. Louis Headquarters and into new markets.

Summary:

The Customer Service Representative is the point of contact for members, providers and other health care professionals by answering any questions pertaining to Essence benefits & the operation.  The individual in this position must take on the following responsibilities: thoroughly investigate & document to the point of resolution all customer service issues; make outbound calls as needed and respond to first level of complexity correspondence; data entery and perform decision making for both paper and electronically submitted claims, claim adjustments, and claims-related activities; must be knowledgeable in all operational processes and communicate issues clearly; must be able to service accurately any plan under the Essence name & apply market specifics when applicable. 

Specific Responsibilities:

Answer inbound calls from members, providers & other health care professionals; must be able to handle volatile situations and act urgently when necessary; cover on weekends to ensure urgent member issues can be addressed ; make outbound calls to any source needed to resolve open issues including but not limited to providers, pharmacies, hospitals etc.; Issue form letters & forms, when appropriate; investigate and respond to general correspondence which may result in a variety of additional actions; data entry and perform edit resolution using decision-making skills for accurate claims processing; follow changing instructions;; work special reports, which identify special claims processing procedures; interact with other departments, i.e. Enrollment, UM, in resolving issues; knowledge of Federal & State Healthcare regulations, Essence benefits and how they are administered, P & P’s, Contracts etc.

Qualifications Needed:

High school diploma or general education degree (GED); or six to twelve months related experience and/or training; or equivalent combination of education and experience.  Candidate must have working PC knowledge and excellent keyboarding skills.  Prefer prior Customer Service & Claims adjudication experience in the healthcare field along with working knowledge of Microsoft Word and Excel.