The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a 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.
The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona, unless an exception is properly authorized in advance.
Major duties and responsibilities include but are not limited to:
• Confer with customer 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.
• Knowledge of AHCCCS rules, regulations, policies, procedures and relevant statutes.
• Knowledge of the principles and processes for providing customer and personal services.
• Skill of speaking to others to convey information effectively.
• Skill of active listening by giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• The ability to interpret and apply policies, procedure, and regulations.
• The ability to multi-task in a fast paced environment.
• One (1) year experience in Medical Claims Processing.
• One (1) year Medical Claims Customer Service.
• One year in a healthcare call center environment
Lifetime Pension Benefit Program
Administered through the Arizona State Retirement System (ASRS)
Defined benefit plan that provides for life-long income upon retirement.
Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
Program administered through Nationwide.
Tax-deferred retirement investments through payroll deductions.
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.
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
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.
The State of Arizona is an Equal Employment Opportunity Employer.