To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.
START DATE: August 16, 2018
TRAINING: 5 weeks paid training.
- 8:00am 4:30 EST
- 8:00am 4:30 CST
- 7:00am 3:30 PST
POST TRAINING: Monday Friday, must be available for 8 hours of work between the hours of 8:00 AM EST to 8:00 PM EST.
- Work hours are not determined until after training and are based on business need.
- Handles customer questions and resolves issues via telephone, internet, or written correspondence from members, providers, and plan sponsors.
- Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors.
- Explains member's rights and responsibilities in accordance with contract.
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
- Responds to requests regarding litigation; lawsuits.
- Handles extensive file review requests. Assists in preparation of complaint trend reports.
- Assists in compiling claim data for customer audits.
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
- Handles incoming requests for appeals and pre-authorizations
- Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.
- Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
- Customer Service experience in a transaction based environment such as a call center or retail location preferred.
- Experience working in a fast paced production driven environment.
- Ability to multi-task to accomplish workload efficiently.
- Analytical skills.
- Ability to maintain accuracy and production standards.
- Computer skills: Microsoft office navigating through multiple screens
- Oral and written communication skills.
- Understanding of medical terminology.
- Problem solving skills.
- Attention to detail and accuracy.
- Negotiation skills.
- High School or GED equivalent required.
BENEFITS ARE EFFECTIVE DAY 1 OF EMPLOYMENT!
Your salary is just one component of your total rewards package. We also offer traditional benefits and: Paid Volunteer Opportunities 152 hours of PTO year 1 Domestic Partner Benefits Employee Recognition Adoption Expense Benefits Wellness Program Tuition Reimbursement and more.
BEHAVIORS AT THE HARTFORD:
- Deliver Outcomes Drive exceptional performance to move the company forward.
- Work as a Team Collaborate inclusively to achieve the best results.
- Build Strong Partnerships Create lasting value through trusted relationships.
- Strive for Excellence Always look for ways to continuously improve.
Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression