Health Insurance Operations Director jobs in Lancaster, PA

limited to):
o Claim status and discount questions
o Provider participation requests for inclusion in the network
o Assist clients, subscribers, and providers with inquiries and problem solving

• Ensures superior client service experience by personally assisting and ensuring all client

• Serves as primary escalation contact for account managers and responsible for collaborating

• Will meet or exceed all quality assurance measures as outlined by the Supervisor or company.
• Log all calls and complaints into Access Complaint/CSR Log database.
• Handle insurance verification calls from providers while focusing on first call resolution.
• Requires the ability to interact with difficult clients, members, and/or providers.
• Repricing of claims and all related processes
• Processing and adjudication of claims.
• Provide appropriate solutions and alternatives in a prompt manner and follow up as necessary

QUALIFICATIONS
To perform this job successfully, Customer Service Representatives must be able to perform each
essential duty satisfactorily. The requirements listed below are representative of the knowledge,
skill, and/or ability required. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.

Must possess the willingness to learn multiple department functions to adequately answer
incoming calls and provide accurate answers.

Requires the ability to interact with difficult clients, members, and/or providers in a courteous,
professional manner.

EDUCATION and/or EXPERIENCE
Associate’s degree (A.A.) or equivalent from a two-year college or technical school; or six
months to one-year related Customer Service experience; or equivalent combination of education
and experience.

Must be proficient in Microsoft platform applications (Word, Excel, and Access database).

Experience in processing claims is helpful, but not required.

LANGUAGE SKILLS
The position will require the ability to read and interpret instructions and procedure manuals;
ability to interpret routine reports and correspondences and the ability to speak effectively and
professionally to clients, providers, and employer groups. Strong customer service orientation
with active listening skills and a high attention to detail with professional verbal and written
skills. Ability to explain policy provisions and other insurance related manners to lay customers
in a clear and concise fashion

MATHEMATICAL SKILLS
Ability to calculate figures and amounts such as discounts, interest, and percentages.

REASONING ABILITY
Ability to solve practical problems and deal with a variety of concrete variables in situations
where only limited standardization exists. Ability to interpret a variety of instructions furnished
in written, oral, or scheduled form. Ability to apply a comprehensive knowledge of PHC and its
products and services as necessary to provide superior service to all customers.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee
to successfully perform the essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit. Specific vision
abilities required by this job include close vision, and ability to adjust focus during computer
operation.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee
encounters while performing the essential functions of this job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential functions.

Activities performed at a fast pace in an oriented office environment.

At times employee may need to interact with difficult clients, members, and/or providers.

3