CSR II Adjudication (18hr + 1Pay for Performance Remote)

JOB TITLE: CSR II Adjudication ($18/hr $1/pay for performance remote)

DEPARTMENT: Operations

REPORTS TO: Supervisor

FLSA STATUS: Non-Exempt

OUR GUIDING PRINCIPLES:

Make every interaction Count

Act with Respect and Integrity

Demonstrate Passion for Continuous Improvement

Be Worth of Trust from all Stakeholders

OVERVIEW:

TheCustomer Service Representative II (Adjudication)ensures compliance with clients program specifications and SaviLinx policies and procedures. This position is responsible for the accurate review input and adjudication of claims.

ESSENTIAL FUNCTIONS:

• Demonstrates ability to work in accordance with theSavilinxGuiding Principles.
• Supportsthe day-to-day processing of claims for a contract with the following duties.
• Acknowledgesestablishment of new claims assigned daily.
• Acceptstelephone calls from claimants.
• Adjudicatesclaims within guidelines ensuring the benefit eligibility is correctly determined.
• Researchesand resolvesescalated and complex claim issuesin a timely manner.
• Reviewssupporting documentation for accuracy.
• Connectswith applicants to guide them through the claim process.
• Maintainsand follows-up on pending files as required by guidelines.
• Practicesall policies and procedures to PHI and HIPAA.
• Documentsallclaimantinformation communications in CRM system.
• Ensuresprivacy confidentiality and precision with all work.
• Maintainsa working knowledge of our clients requirements.
• Regular and consistent attendance is an essential function of the job.

SUPERVISORY RESPONSIBILITY:

No Supervisory responsibility.

EXPECTED WORKDAYS/ HOURS:

This position requires work Monday-Friday 8am-5pm.

LOCATION:

Work from Home based on performance and internet connectivity.

QUALIFICATIONS:

• 2 years of contact center experience preferred.
• High school diploma or equivalent required.â
• Time management skills and the ability to work independently are essential for this role.
• Must have experience with maneuvering electronic data between various environments.
• Analytical thinking communication and writing skills and computer competencies.
• Prior experience with PHI or HIPAApreferred
• 2 years of college preferred.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.

EQUAL EMPLOYMENT OPPORTUNITY:

SaviLinx LLC provides equal employment opportunities to all employees and applicants for employment andprohibits discrimination and harassment of any type without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.

VEVRAA FEDERAL CONTRACTOR/EQUAL OPPORTUNITY EMPLOYER