We're Sutherland, and we are seeking attentive, goal-oriented individuals to support the expanding needs of one of our largest health insurance company customers. In this role, you will be responsible for the following:
- Delivering an exceptional customer experience by responding to incoming calls from both in-network and out-of-network providers to assist with simple and complex inquiries
- In times of high call volumes, phone calls may be received back-to-back with an “All Hands on Deck” approach
Duties & Responsibilities;
- Assist providers with claims and claims investigations
- Status Inquiries
- Denial Rationale
- Appeals
- Research and Routing
- Explanation of Payments / Explanation of Benefits Requests
- Authorizations
- Status Inquiries
- Denial Rationale
- Utilization Management Appeals
- Prior Authorization Verification
- Eligibility and Benefits
- Status Inquiries
- Interpreting Medical Benefit Grids
- Verification of Provider Participation
- Credentialing Inquiries
- Documentation
- Provider Inquiries & Specific Details
- Information provided on the phone call
- Routing Pathways
- Self-Service Options
- Assisting providers with education on available Self-Service Options
When you join us, you’ll enjoy;
- Competitive pay rate of $16/hour
- Medical, dental and vision benefits
- Paid training
- Global Flexible Vacation Policy after training
- Company-provided equipment
- Advancement opportunities – 80% of our frontline leaders have been promoted from within
- Monthly rewards & recognition programs
- Employee Discounts
- EAP & Health and Wellness programs including a personal trainer dedicated to Sutherland
- Weekday schedule, Monday-Friday, 8AM-5PM EST
Requirements
Required Qualifications
- High School Diploma or equivalent
- 1-2 years of experience working in a high-volume call center environment as a customer service representative
- Effective verbal and written communication skills
- Strong typing and analytical abilities
- 40 Words-Per-Minute typing-speed
- Active listening and problem-solving abilities
- Soft skills and positive attitude
- Multi-tasking skills with a strong attention to detail
- Time Management skills
- Sufficient Internet speeds while connected to a Remote Desktop Session (10MB Download / 2MB Upload)
- Quiet and distraction-free dedicated workspace
- Schedule adherence – Be present and on-time
Preferred Qualifications
- 1-2 years of experience in a medical office setting
- 1-2 years of experience with healthcare insurance
- Medicaid experience highly favored
- 1-2 years of experience with billing or coding
- 1-2 years of experience with back-end processing
IMPORTANT NOTE: This job is open only to residents of the United States, and you must be authorized to work in the US in order to be considered for employment.
Sutherland
Sutherland is seeking an organized and goal-oriented person to join us as a Team Leader for Banking & Financial Account
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