The Medical Call Center Specialist serves as a key customer service representative, handling incoming calls from participants, providers, and other stakeholders while processing health insurance claims. This role requires adherence to eligibility, claims, and call policies and procedures, ensuring accurate and timely resolutions. Responsibilities include answering inquiries, resolving issues, fulfilling requests, and maintaining performance standards in efficiency, accuracy, and customer satisfaction.
Key Responsibilities:

Answer high-volume incoming calls and assist with benefit, eligibility, billing, payment, and claims inquiries
Document information accurately and communicate clearly with customers to resolve issues
Process and review healthcare claims using multiple systems, ensuring proper application of benefits and compliance with policies
Research and resolve claim-related problems, escalating when necessary
Maintain strong customer relationships through professional and empathetic service
Meet established performance metrics for quality, productivity, and attendance

Requirements:

Bachelor's degree required
Minimum of 4 years of call center experience
4 years of claims processing experience preferred
Knowledge of medical terminology preferred

Skills:

Strong analytical and problem-solving abilities
Excellent verbal and written communication skills
Proficiency in Microsoft Office Suite
Ability to work in a fast-paced environment and manage multiple priorities

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.