Eligibility Research Representative I

Administrative Fort Worth, Texas Carmel, Indiana


Description

American Specialty Health Incorporated is seeking a detail oriented research representative for our Eligibility team. This position will research and resolve eligibility verification requests while providing the highest quality of customer service by maintaining a professional and courteous manner. The ideal candidate will have strong typing and 10-key skills while maintaining 98% accuracy. The research representative follows confidentiality guidelines to ensure security measures are enforced and proprietary information remains protected.

Responsibilities

  • Verifies member eligibility from the eligibility file, communications logs, and health plan websites or by calling the health plan directly when all other resources are exhausted.
  • Inputs and saves verified member’s information into the communications log and/or member maintenance.
  • Promptly processes and completes research to ensure turnaround times are met.
  • Makes follow up calls to practitioners and members to provide research results.
  • Builds or updates member and group records in ASH’s proprietary claims processing system including documentation in notes.
  • Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected
  • Must maintain a minimum production level of 85 claims, 60 CSS/MNA, or 60 Ashlink requests per day pro-rata with no less than 98% accuracy.
  • Ability to assist in multiple functions as needed.
  • Ability to participate in peer mentorship as needed.

Qualifications

  • High School Diploma required.
  • Minimum one year experience with 10 key, typing, and computer skills. 8,000-10,000 key strokes per hour required.
  • Excellent customer service skills, experienced in making outbound calls and meeting expectations for productivity and accuracy required.
  • Experience with claims processing or eligibility verification preferred.

COVID-19 Considerations:

The safety of our employees, both current and future, is ASH’s highest priority. At this time, most of our employees are working remotely due to the current COVID-19 pandemic. Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment. Once ASH determines employees can return the office, candidates may be required to work in a local office. Limited visits to the office in person may be required. While onsite, social distancing and masks are required along with adherence to ASH’s Communicable Disease and Pandemic Policy.

Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.