Activities:
Oversee routine claims processing functions including mailroom, scanning or data entry processes
Assist in creating call and claim processing flows and functions of the telephony and claim processing system.
Support the creation of Operational documentation and other documentation as needed
Support the creation of operational documentation and other documentation such as claims processing manuals, SOPs and job aids
Testing of the new system
Assist with new hire training and cross training of existing staff
Support creating and maintaining staff schedules
Ensure that the call center, mailroom, data entry and claims resolutions is operational Monday-Friday 7:45 AM to 5:00 PM EST (except approved holidays)
Ensure SLAs are compliant with Government and Supplier expectations
Become knowledgeable of the mailroom equipment and processing of claims
Ensure courier runs are completed timely
Ensure SLAs are compliant with Government expectations
Maintain retention policy requirements for paper claims
Knowledge of Medicaid processing procedures (Preferred)
Monitor and evaluate agent performance, providing learning or coaching opportunities, and taking corrective action, if necessary.
Work with Quality Management to ensure staff is knowledgeable and processing inquiries and claims effectively
Conduct regular training sessions for claims, mail room, and data entry staff to ensure they are up to date with Government/Company practices.
Address and resolve escalated customer service issues
Partner with systems team in developing processes related to new claim edits and audits.
Other duties as assigned
Pre-requisites:
High School Diploma or equivalent, 2-year post-high school Degree, or Bachelor's degree. Typical, 2-4 years of working experience in related fields
Minimum of three years leadership experience
A minimum of two years of previous experience for a government or private sector inbound customer service center or related field. (Preferred)
Knowledge of basic help desk software, computer software and Microsoft Office applications.
Problem-solving skills to bring inquiries to effective resolution.
Customer service skills with an emphasis on written and oral communication to respond to inquiries professionally.
Organization skills to balance and prioritize work with the ability to multi-task
Work Requirements:
Hours of Operation: Within the hours of 7:30 AM -5:30 PM, Eastern Time, Monday - Friday candidate must be able to work any assigned 8-hour shift between these hours.
Work environment is onsite in Washington DC.