Customer Solutions Representative

Ultimate Staffing Services is seeking a dedicated and knowledgeable Customer Solutions Representative to join a dynamic team in beautiful Tarpon Springs. The representative will play a vital role in managing insurance-related inquiries and ensuring customer satisfaction through effective communication and resolution of account issues.

Responsibilities:

• Respond to inbound calls, emails, and messages from patients, insurance carriers, and providers regarding insurance billing and claim issues.
• Provide clear and accurate information regarding claim status, benefit coverage, balances, co-pays, deductibles, and authorization requirements.
• Resolve or escalate customer concerns involving insurance denials, coordination of benefits (COB), and payment disputes.
• Investigate account balances by reviewing EOBs, remittance advices, claim notes, and insurance policies.
• Contact insurance carriers as needed to verify claim receipt, payment status, or denial reasons.
• Work with internal billing and coding staff to resolve discrepancies and ensure appropriate follow-up on claims.
• Document all customer interactions and actions taken within the billing system or CRM.
• Track open issues and ensure timely follow-up and closure of outstanding inquiries.
• Assist in preparing letters or forms required for appeals, corrected claims, or additional documentation requests.
• Educate patients on insurance terminology, claim processes, and their financial responsibilities.
• Explain payment options, including setting up payment plans or connecting them with financial counseling services.
• Help patients understand coordination of benefits, prior authorization requirements, and out-of-network implications.

Job Skills & Qualifications:

• Solid understanding of medical insurance including deductibles, copay, and coinsurance is highly preferred.
• Experience with verifying and interpreting medical benefits for Medicare, Medicaid, major commercial health insurance, and secondary payers required.
• Experience processing provider referrals and prior authorization requests.
• Understanding of medical terminology and ICD-10 codes and Diagnosis.
• Familiar with individual payer guidelines and authorization/referral requirements based on insurance plans.
• Ensure complete and accurate information maintained in patient account including authorization or referral received from payer or Primary Care Physician.
• Strong people skills required; diplomatic, patient, flexible, and able to multi-task and be cross-trained on all functions within the Insurance Verification Department.
• Must be mobile in an office setting, sitting, standing, walking, and bending.
• Perform general duties and other functions as required or assigned.
• Working knowledge of Microsoft Suite including Excel, Word, and Outlook.

Work Environment:

This job operates in a professional office environment and routinely uses standard office equipment.

Physical Demands:

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

Required Education and Experience:

• High School Diploma
• 2 years of medical insurance verification and benefit experience

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Benefits and Additional Details:

Compensation ranges from $18 to $22 per hour, based on experience.

Work Hours:

Monday - Friday

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.