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Claims Customer Service Rep 3

  • 501949
  • PHOENIX
  • AHCCCS
  • Full-time
  • Closing at: Oct 20 2021 at 23:55 MST

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

Claims Customer Service Rep 3

Posting Details:

Salary: $27,111 - $33,000 

Grade: 16

Closing Date: 10/20/2021

Job Summary:

This position is open to current AHCCCS employees.

The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Customer Service Rep 3. After a successful training period, this position will work primarily from home, with some in-office meetings and on-site duties being required. Interaction with customers in the Division of Fee for Service Management’s Claims Customer Service Unit to provide information in response to inquiries about products and services and to handle and resolve complaints regarding their claims. Major duties and responsibilities include but are not limited to:

Job Duties:

• Confer with customers by telephone to provide information about their claims, prior authorization requirements, and eligibility information.

• Researches provider claims and prior authorization inquiries to provide status and identify billing, procedure or processing problems. Refers to appropriate areas for additional claim research if needed.

• Collects documentation for resubmission of claims and prior authorizations. Assures quality of claims in each phase of the claims process.

• Exercises discretion to interpret and apply customer service procedures, prepares documentation for research and coordinates resolution of provider issues between various claim departments.

• Performs lead customer service activities by providing assistance, guidance, and instruction to less experienced customer service representative regarding the most complex customer service inquiries and issues. Attends information meeting within Division of Fee for Service Management (DFSM) to give and receive training.

• Other duties as assigned as related to the position.

Knowledge, Skills & Abilities (KSAs):

• Administrative and clerical procedures and system such as word processing, managing files and records.

• Critical thinking skills, using logical and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches and regulations.

• Ability to interpret and apply policies, procedures, and regulations.

• Ability to plan, organize, and prioritize work.

• Ability to multi-task in a fast-paced environment.

• Knowledge of AHCCCS rules, regulations, policies, procedures, and relevant statutes.

Selective Preference(s):

• Minimum of 1-year experience in medical claims processing.

• Minimum of 1-year medical claims customer service.

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

ARIZONA MANAGEMENT SYSTEM (AMS)

All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress.  Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.  
State employees are highly engaged, collaborative and embrace a culture of public service.

Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.