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Medicare Customer Service Representative Inbound/Outbound

Company: PacificSource Health Plans
Location: Bend
Posted on: November 28, 2018

Job Description:

Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate research and follow-up for prompt resolution of disputed claims. This position requires occasionally working a late shift or weekend hours.


  • Work efficiently in a high volume call center while maintaining a professional, polite manner.
  • Assist callers with coverage related questions; accurately interpret policy provisions for group and individual business.
  • Analyze customer's inquiries and determine steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and organized.
  • Document calls in a clear and consistent manner in computer system.
  • Conduct appropriate research and follow-up for prompt resolution of disputed claims.
  • Relay information to appropriate departments and personnel using established communication channels and procedures.
  • As needed, make outbound calls to members dependent upon current outreach campaign.

    Supporting Responsibilities:

    • Meet department and company performance and attendance expectations.
    • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning

      confidentiality and security of protected health information.
    • Perform other duties as assigned.

      Work Experience: One year medical insurance, other healthcare related field or call center experience required.

      Education, Certificates, Licenses: High School Diploma or equivalent required.

      Knowledge: Understand insurance and medical terminology, coding and standard medical billing practices. Proficient computer skills, typing, and 10-key required. Medical terminology, CPT/ICD-10 coding preferred.
      Competencies

      Our Values


      • Building Customer Loyalty
      • Building Strategic Work Relationships
      • Continuous Improvement
      • Adaptability
      • Building Trust
      • Work Standards
      • Contributing to Team Success
      • Planning and Organizing


        • We are committed to doing the right thing.
        • We are one team working toward a common goal.
        • We are each responsible for our customer's experience.
        • We practice open communication at all levels of the company to foster individual, team and company growth.
        • We actively participate in efforts to improve our many communities-internal and external.
        • We encourage creativity, innovation, continuous improvment and the pursuit of excellence.
          Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.

          Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

          Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

          PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

          Keywords: PacificSource Health Plans, Bend , Medicare Customer Service Representative Inbound/Outbound, Hospitality & Tourism , Bend, Oregon

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