Claims Customer Service Representative

Job Summary: Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions to provide prompt, courteous customer service, which meets or exceeds service standards. Interpret contract benefits in accordance with specific claims processing guidelines. Primary Responsibilities other duties may be assigned as necessary : Interpret contract benefits accurately to policyholder, agents, and providers. Provide claim status to policyholders or providers. Send out refund request letters and follow-up as necessary. Produce correspondence to customers. Answer calls as required by company policy in a helpful, professional, timely manner. Place outgoing calls as needed to provide or obtain information.…