Do you enjoy helping others, answering questions and resolving problems? Do you have any experience in the healthcare/medical field or are you interested in pursuing a career in the field? Are you looking for an opportunity to build a fulfilling career while **working from home** ? **Join Us.** 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
**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.
- *_About Us_**
_Sutherland, recently recognized as a Great Place to Work in the US, is a digital transformation company, making digital processes feel more human for the customers that we serve. We have been helping customers globally, across industries from financial services to healthcare, entertainment to retail, insurance to gaming, and everything in between, provide exceptional experiences for their customers for over 35 years._ EEOC and Veteran Documentation During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION. #J-18808-Ljbffr
strong-typing active listening Color theory Analytical skills Attention to details medical Billing Customer service time-management technical education Cooperation Healthcare industry claims Positive attitude Software Developer