Customer Service Coordinator

🔥 17 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $26 - $36 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sharp HealthCare

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

🧘 Wellness

Healthcare • Nursing • Wellness

Sharp HealthCare is a healthcare organization dedicated to providing high-quality medical services to patients and families. With a commitment to innovation, safety, and excellence, Sharp HealthCare offers a range of career opportunities in nursing, clinical support, administration, and various medical specialties. The organization emphasizes a collaborative work environment and is recognized for its nursing excellence, aiming to advance the science of medicine alongside compassionate patient care.

📋 Description

• Provide support service, education, research, and informational support to internal and external customers of Sharp Community Medical Group • Collect and compile utilization data • Develop systems to collect and compile data for Utilization Management analysis of medical practice patterns, compliance patterns, and utilization policies and procedures • Handle incoming calls and provide prompt, courteous customer responses • Maintain a grade of 100% • Triage calls from providers, health plan members, and health plans • Record and track member, provider, and health plan issues in the Customer Service Computer Module • Ensure timely follow-up on all issues • Perform Service Recovery: Apologize, Correct, Track, and Take Action • Perform other duties as assigned • Research and advise on claims adjudication, eligibility referrals, and appeals • Maintain relationships with the claims department for claims adjustments and issue resolution • Work with Health Services Management on authorization issues and ensure prompt responses to providers regarding appeals, quality, and eligibility issues • Develop educational programs for providers on referral processes and status, benefit and claims status, out-of-area emergencies, physician selection, and eligibility processes • Apply principles and knowledge of utilization management, community standards, and health plan benefits • Create and make determinations on authorizations for medical services in coordination with Health Services Management • Educate office staff and providers on the appeal process

🎯 Requirements

• High School diploma or equivalent • 3 years' experience working in the managed health care field with exposure to patient issues including claims, eligibility, appeals, and benefit level determination • 1 year experience working in a high-volume call center • Excellent organizational and time management skills • Good concentration skills • Excellent verbal skills on the telephone and written communication skills • Proficiency in medical terminology • Basic knowledge of medical treatment regimens and standards of practice • Knowledge of Health Plan Benefits • Computer skills and data input/look-up skills in IDX preferable • Advanced ability to work independently in research and decision making • Ability to sit for extended periods of time with typing/input speeds equivalent to 35–40 wpm