The Validation Representative Customer Service will perform all or some of the following Job description:

• Provide expertise claims support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities

• Analyze and identify trends and provide reports as necessary

• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance

• Provide superior customer service for incoming and outgoing telephone calls to or from members, providers, employer groups or other persons deemed necessary by management

• Initiate outgoing telephone calls to obtain additional information required by COB and Third Party Liability. 

• MS Microsoft Word, Excel
• 2+ years customer service experience within an outbound call center (must be within the last 3-5 years)
• Previous experience within a production driven environment
• Proven record of meeting metrics and superior quality scores
• Previous Healthcare insurance experience strongly preferred
• Previous Coordination of Benefits (COB) experience is strongly preferred
• MS Access experience is preferred.