McLaren Health Care Customer Service Rep in Indianapolis, Indiana
MDwise, Inc. Opportunity – Customer Service Representative
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 to help vulnerable populations needing health coverage in Indiana. Our parent organization, McLaren Health Care , is a nonprofit integrated health system who believes all Indiana families should have access to high quality health care regardless of income. Our mission is to provide high quality health care. MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.
MDwise is seeking the right individual to join our team in our Customer Service department. As an employee of MDwise, you will be a part of a dynamic organization that considers all of our employees as leaders in driving the organization forward and delivering quality service to all our members.
Learn more about MDwise, Inc. at https://www.mdwise.org/ .
The Customer Service Representative position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.
High School Diploma or equivalent certification.
Must be proficient in English and Spanish languages
Two (2) years’ experience in a high-volume call center.
In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
Associate Degree in business, health care or related field.
Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts).
Primary Location: Indiana-Indianapolis-MDwise Inc
Employee Status Regular
Shift Day Job
Job Type Standard
Req ID: 21001463