Description: Answers questions and resolves issues based on phone calls/letters from providers. Provide excellent customer services for high volume inbound provider calls. Extensive claims research on multiple platforms. Uses customer service threshold framework to make financial decisions. Processes claim referrals, new claim handoffs, nurse reviews, and provider complaints. Educates & assists providers on our self-service options. Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility. Performs review of member and provider claim history. Requirements: Familiarity with Microsoft Office products Excellent computer skills using multiple screens and systems Experience in highly transactional call center environment Excellent customer service and critical thinking Secure, private home office location High speed internet access (100 mbps or higher) Benefits: Full range of medical, dental, and vision benefits 401(k) retirement savings plan Employee Stock Purchase Plan Fully-paid term life insurance Short-term and long-term disability benefits Well-being programs Education assistance Free development courses CVS store discount Paid Time Off (PTO) Paid holidays Apply Job!