Job description

Qualification Requirements
To perform this job successfully, an individual 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.
Minimum Qualifications
Graduation from high school or has obtained a General Education Diploma
1 or more years’ experience, preferred
Knowledge, Skills and Abilities
Must be proficient in MS Office products and Outlook programs
Excellent verbal and written communication skills required.
Ability to utilize the available time to organize and complete work within given deadlines.
Ability to work independently with minimal supervision.
Ability to communicate in writing clearly and concisely
Ability to communicate effectively with others using the spoken word.
Ability to take care of the customers’ needs while following company procedures.
Ability to pay attention to the minute details of a project or task.
Ability to get along well with a variety of personalities and individuals.
Report any issues, concerns, ideas or recommendations in the department Customer Service Manager
Essential Functions
Answering customer calls regarding claim status, eligibility and benefit for medical and dental plans.
Obtain and handle faxes received from providers/PPOs regarding benefits, claim status and payment information.
Responds to emails from participants and/or providers.
Faxes or emails medical or dental eligibility/benefits to providers and/or participants.
Obtain explanations of provider payments (EPPs) from the ECHO website and fax/email to providers and participants.
Trace checks for providers and/or participants handle virtual payment issues with the outside vendors.
Responds back to the caller with detailed payment information.
Act as liaison with account managers on PBM/RX issues.
Act as liaison between Cigna providers and Cigna.
Informs manager regarding verification of benefits (VOB) enhancements or corrections are needed.
Create tickets in regards to disputes or appeals with Cigna.
Assist participants with finding a participating provider on Cigna’s website.
Determine if procedures require pre-certification with Cigna and CareValent.
Physical Demands
While performing the duties of this job, the employee is regularly required to talk or hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

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