Customer Service Representative

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.