University of Utah Health Care

Returning Candidate?

Claims & Customer Service Advocate

Claims & Customer Service Advocate

Requisition Number 
27952
Reg/Temp 
Regular
Employment Type 
Full-Time
Shift 
Day
Work Schedule 
8am to 6pm
Location Name 
University of Utah Health Plans
Patient Care? 
No
City 
Murray
State 
UT
Department 
UIP CST 01H UUHP OPERATIONS
Category 
Insurance / Health Plans

More information about this job

Overview

As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in Health Plans Departments only.

The Claims and Customer Service position is responsible for providing world class customer service to our members and providers by demonstrating empathy, advocacy and expertise. This position process claims and answers inquiries while optimizing efficiency, service and quality. Seeks to optimize the member and provider experience by offering one call resolution by being experts in benefits, eligibility and claims processing.

This position is not responsible for providing care to patients.

Responsibilities

  • Supports and promotes UUHP’s mission, vision, values, and goals.
  • Contributes to positive and productive team environment.
  • Accountable for customer service and claim performance expectations.
  • Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnoses and procedures.
  • Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
  • Follows adjudication policies and procedures to ensure proper payment of claims.
  • Provides prompt customer service to members, providers, billing departments and other insurance companies regarding claims.
  • Documents phone calls in system and follows up on issues if needed.
  • Resolves problems resulting from claim adjudication and customer service phone calls.

Knowledge / Skills / Abilities

  • Ability to perform the essential functions of the job as outlined above.
  • Experience with claims processing in a health care delivery setting or insurance payer.
  • Customer service experience.
  • Ability to work effectively, independently, and as part of a team.
  • Strong organization, time management and project management skills and multi-tasking abilities.
  • Detail oriented with problem-solving abilities.
  • Demonstrates strong communication skills.

Qualifications

Qualifications

Required

  • Three years experience as a medical claim processor or equivalency.

Qualifications (Preferred)

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking, Standing