Medical Claims Enquiries Customer Service Representative

1 month ago

Victoria, British Columbia, Canada PBC Solutions Full time
Job Title: Medical Claims Enquiries Customer Service Representative

PBC Solutions is seeking a highly skilled and detail-oriented Medical Claims Enquiries Customer Service Representative to join our team. As a key member of our customer service team, you will be responsible for providing exceptional service to our clients, answering their queries, and resolving their issues in a timely and professional manner.

Key Responsibilities:
  • Answer public and provider calls, articulating client policies clearly and neutrally.
  • Assist callers in the use of online forms and in submitting applications/documentation/claims.
  • Control calls, paraphrasing, actively listening, empathizing, and acting to resolve issues.
  • Update IT systems with validated provider information, troubleshoot provider connectivity problems, and determine solutions.
  • Electronically issue patient files and remittance statements, delete medical claims submitted in error, and utilize situational judgment skills.
  • Resolve escalations from other departments, perform repetitive tasks, and answer repetitive questions.
  • Use a computer for long periods, process requests for reimbursements and documents provided by providers and the public, and validate information and documentation.
  • Apply HIBC policies, update IT systems accordingly, release personal information to 3rd party requesters, and correspond with the public/providers to explain policy decisions and seek or provide information.
  • Process requests for medical histories, validate information and documents provided by the public, make decisions on and initiate reimbursements directly to beneficiaries, interpret and use medical information, and verify that cheques have not been cashed.
  • Correspond with the public/providers to explain adjudication decisions or request additional information, understand and comply with policies/procedures set by PBCS, legislation, and clients, and escalate work beyond the level assigned.
  • Obtain required approvals, document notes and actions, and utilize designated channels and systems for making recommendations, communicating, reporting, etc.
  • Report non-compliance of policies and procedures, adhere to work commitment and daily schedule, manage personal time, track and update weekly/monthly schedule expectations, and report time accurately.
  • Manage interactions with callers, clients, and colleagues respectfully, collaboratively, and professionally to contribute to a harmonious, productive work environment.
Requirements:
  • High school diploma or GED equivalent, including a 65% grade in Grade 12 English and Math, required, may be subject to standardized testing.
  • Intermediate level of the MS Office Suite, including Excel and Word.
  • Ability to operate standard office equipment, typing speed of at least 40 wpm with a 98% accuracy, and minimum 1 year of experience working in a call centre environment.
  • Effective communication, managing diverse relationships, organizational savvy, multiple demands and time management, conflict management, customer focus, balancing stakeholders, decision quality, and required competencies.
What We Offer:

PBC Solutions offers a robust health & dental benefits plan, with flexible options that will meet you and your family's needs, and a Defined Benefit Pension Plan (PSPP) for all eligible employees.

We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race, ethnicity, gender or gender identity, sexual orientation, religion, ability, education level, parental status, or socioeconomic status.

PBC Solutions is an equal opportunity employer and welcomes applications from all qualified candidates.

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