Experienced Group Health Customer Service Representative – Insurance Claims Processing and Review Coordination
About Dane Street
Dane Street is a dynamic and innovative company that has been making a significant impact in the insurance industry for years. As a fast-paced, Inc. 500 Company, we pride ourselves on our high-performance culture and our commitment to delivering exceptional results for our clients. With a strong focus on customized Independent Medical Exam and Peer Review programs, we assist our clients in reaching the appropriate medical determination as part of the claims management process. Our team of experts processes over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers.Job Summary
We are seeking an experienced Group Health Customer Service Representative to join our team. As a key member of our critical relationships with clients, technical teams, and operations teams, you will be responsible for the scheduling and selection of reviewers for referrals received within the Dane Street Network. If you are a highly motivated and organized individual with excellent communication skills, we encourage you to apply for this exciting opportunity.Description of Key Tasks and Responsibilities
As a Group Health Customer Service Representative, you will be responsible for the following key tasks and responsibilities:- Handling Receipt of New Cases: Intake new cases and review/verify information and requests. Draft cases by entering information into the Dane Street system, AccessDS.
- Work with Client on Any Information Missing Pertinent to Processing Claim: Collaborate with clients to gather any missing information necessary for processing claims.
- Sort, Organize, and Create Medical Document Listing: Sort, organize, and create medical document listings as required by clients and in line with specific special handling.
- Oversight of Cases: Monitor, process, and track cases to ensure we meet deadlines.
- Assignment of Cases: Assign/schedule new cases to physicians for review with the appropriate physician, based on location, reviewer availability, specific guidelines, jurisdictional requirements, and other client requirements.
- Ensure that the Assigned Physician Has No Conflict of Interest with the Case Assignments: Verify that the assigned physician has no conflict of interest with the case assignments.
- Client Interaction: Update clients frequently on cases in progress and communicate with clients when there are questions on referral information to ensure proper documentation and information is provided to the assigned reviewer.
- Ensure Proper Documentation for Specified Cases is Provided to the Client: Ensure that proper documentation for specified cases is provided to the client.
Special Skills and Attributes Required
This position involves a substantial amount of communication with clients and physicians/physicians' offices via phone and email, and constant computer work. Therefore, candidates MUST possess the following skills/experience:- A Minimum of 1 Year of Experience Working in an Administrative or Clerical Role in a Business Office Environment: A minimum of 1 year of experience working in an administrative or clerical role in a business office environment is required.
- Experience Working in a Healthcare (Medical Office, Insurance Claims, etc.) Environment Preferred: Experience working in a healthcare (medical office, insurance claims, etc.) environment is preferred.
- Excellent Computer Skills (Apple Operating System, Google Chrome Search Engine, Gmail are Preferred): Excellent computer skills, including proficiency in Apple Operating System, Google Chrome search engine, and Gmail.
- Stellar Written and Verbal Communication Skills, Including a High Comfort Level in Speaking with the Referring Client, Claimants, and/or Physician: Stellar written and verbal communication skills, including a high comfort level in speaking with the referring client, claimants, and/or physician.
- Ability to Maintain Focus and Attention to Detail in a Fast-Paced Environment: Ability to maintain focus and attention to detail in a fast-paced environment.
- Ability to Manage Multiple Tasks and Quickly Changing Priorities: Ability to manage multiple tasks and quickly changing priorities.
- Excellent Organizational Skills: Excellent organizational skills.