Call Center Clerk

Job Description Summary

Under the direction of the Senior Supervisor, Customer Service, this position performs a range of various clerical and administrative duties in support of the Customer Service team for Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management (PCMI). The Call Center Clerk will aid in the documentation of processes and participate in any project that will benefit the department. This position will also support the customer service team by routing all incoming or outgoing correspondence as well as mail, fax forms, or copy requests as requested by providers or members. This role will also serve as backup for telephone and web-based member/provider inquiries.

Duties And Responsibilities

Administrative Support

• Review, respond to, and process daily clerical inquiries received via fax, mail, email, and all general clerical correspondence through telephone or email queues.
• Prescreen claim documents to ensure validation and accuracy prior to processing.
• Cross-reference all claims and correspondence received from new or established providers and members in order to determine accuracy.
• Prepare routine reports and assist the Senior Supervisor with ad hoc projects as assigned.
• Analyze problems and provide information and solutions.
• Assess and report performance in terms of impact, making improvements, and course correcting along the way. Be accountable for helping the Customer Service department.
• Research and resolve aged Customer Service open calls within company standards.
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and promptly.
• Lead and respond to escalated customer inquiries regarding billing issues.

Call Center Support

• Process Customer Service representative form requests.
• Resolve Customer Service Check Tracers by interacting with internal associates/external sources.
• Thoroughly document the routing of claims to examiners and other department inquiries.
• Maintain a status report on all calls referred to other departments, return calls, and/or documentation requests and follow-ups sent to outside sources. This includes making outbound calls, sending messages via internal systems for tracking and continuity, and returning messages.
• Prescreen and process HIPAA requests and verify all required items are submitted accurately.
• Resolve Customer Service Virtual Credit Card (VCC) requests, Stop Pay and Check Tracer Requests.
• Serve as a liaison to the financial transactions department to assist in reconciling overpayments, Stop Pay requests, or returned checks.
• Provide phone backup to the Customer Service department as needed.
• Operate in the Health Care Processing System (HCPS), Imaging systems, and all systems necessary to obtain and extract information. Ensure the accuracy of documentation to maintain HIPAA compliance within these systems.
• Meet and maintain telephone performance measures per Customer Service Performance reports based on department goals and metrics.

Other

• Maintain regular attendance per employee handbook guidelines
• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• Serve as a representative of WGAT and PCMI, displaying professionalism, knowledge, quality customer service, and discretion in all interactions with other members of the WGAT and PCMI community and their customers.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.