Position Summary:

The Meritage Call Center Representative provides prompt, accurate and courteous responses to written and telephonic inquiries. These inquiries encompass numerous contacts and originate from subscribers, members, physician offices, and Health Plans; and typically involve a variety of issues including benefits, pricing, claim rejections, authorizations, and claim status.

Essential Job Functions:

• Ability to research and accurately resolve problematic claim situations.
• De-escalate situations involving dissatisfied customers, offering patient assistance and support.
• Provide full customer service where you could accept inbound or might be calling out to provide follow up on a concern.
• Maintain customer accounts and information.
• Respond to customer inquiries with compassion and active listening and support the best solution in an efficient manner.
• Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seeks to influence these behaviors in others.
• Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and Compassion.
• Models professional work standards and behaviors to maintain and strengthen a professional working atmosphere and strictest confidentiality within the department and with other Meritage internal and external customers and work partners.
• Is accountable for work performed by self, works to develop and maintain trusting working relationships with others, and seeks to continuously learn from errors and experiences, as well as new developments in job specific Call Center administration and operational areas.
• Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term strategic business goals and objectives while performing work duties, special projects and other duties as assigned within or outside of the Call Center.
• Seeks to continuously learn from errors and experiences, as well as new developments in job specific areas.
• Performs other than normally assigned duties, as directed, and required, within and outside of the department to support Meritage’s overall business needs, goals, and objectives.
• Initially and on an ongoing periodic basis, spends time with each HR staff member, payroll and other identified internal staff to gain an understanding of their job duties, challenges, and to better identify and support an effective continuum of workflow with Meritage, to support continuous process improvement and remove any roadblocks impacting productivity.

Required Skills, Knowledge and Abilities

• Multi-task and keyboard while researching, following up, resolving, and documenting telephonic inquires.
• Knowledge of claim benefit interpretation/benefit adjudication logic.
• Must be proficient in problem solving and detecting trends.
• Excellent communication skills – meaning you can adapt to new and different situations, read the behavior of others, have difficult conversations with ease and defuse and resolve conflict.
• Must be able to read and interpret all types of authorization, medical claim forms and member benefit plans.
• Integrity to follow HIPAA guidelines on maintaining patient privacy.
• Ability to adapt and excel in a fast-paced work environment.

Education and Experience

• High School Diploma or GED required.
• 3-4 years previous claims customer service experience or call center.
• Familiarity of medical terminology preferred.
• Prior experience with medical coding (ICD10, CPT) preferred.
• Microsoft Office Suite applications: Word, Excel, PowerPoint, etc.
• Customer service experience in a healthcare related field- HMO experience preferred.

Job Type: Full-time

Pay: $19.85 - $23.52 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Customer service: 3 years (Required)
• Call center: 3 years (Required)

Work Location: Hybrid remote in Novato, CA 94949

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