Activities:
Please make an application promptly if you are a good match for this role due to high levels of interest.
· 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.