Customer Service Representative

Job Summary:

Responsible for providing accurate and timely customer service for all external Stirling Benefits, Inc. clients by utilizing high-quality in-depth knowledge of company products, services and internal employee resources.

Essential Functions/Responsibilities:

• Partner with team members including account managers and claim analysts to provide clients with service as outlined in Administrative Agreement, Summary Plan Document and Summary of Benefits.
• Provide timely and accurate response to requests from customers on general claims for our retiree book of business

• Work closely with the Retiree Claims Analysts on claim payment issues.
• Work closely with the Client Services/Funding Department to resolve incorrect claim payment issues.
• Effectively and accurately communicate with providers, clients and participants in oral and written form.
• Provide timely feedback to the company regarding service failures or concerns.
• Demonstrate the ability to understand the process of payment of health claims from entry to specific stop loss submission.

Additional Non-Essential Functions/Responsibilities:

• Set up Scan files
• COB and Section 111 updates
• Occasional attendance of Company sponsored events or offsite health fairs during or after regular work hours

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Education/Equivalent Experience:

Undergraduate Degree required. Minimum two (2) years experience preferably in Health Claims Customer Service. Familiarity with processing health claims to include CPT, ICD-9 coding and medical terminology preferred, and/or any combination of education and experience to successfully perform the essential function of the job.

Skills/Knowledge/Abilities Required:

• Ability to organize and manage multiple priorities
• Strong Customer orientation
• Excellent interpersonal and oral/written communication skills
• Ability to work well with others in a multi-task working in a team environment
• Strong PC skills with proficiency using email and scanning
• Ability and willingness to work on multiple database systems
• Ability to read, analyze, and interpret documents
• Ability to apply concepts such as fractions, percentages, ratios, and proportions
• Ability to interpret an extensive variety of abstract and concrete variables
• Ability to define problems, collect data, establish facts, and draw valid conclusions

Physical Demands:

The physical demands listed are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: Walking for less than 1/3 of each day. Sitting for more than 2/3 of each day. Frequent use of fingers, hands and arms for using a computer keyboard or writing for more than 2/3 of each day. Occasional lifting of materials weighing up to 10 pounds. Speaking and hearing are required for communication purposes. Must bend, kneel, sit, stand, squat. Close and distant vision and an ability to adjust focus.

Work Environment:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an environmentally-controlled office setting, with no exposure to adverse conditions.

Job Type: Full-time

Salary: $37,000.00 /year

Required education:

• Bachelor’s

Required experience:

• Customer Service: 2 years