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 UsSutherland, 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 DocumentationDuring 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.