Remote Claims CSR Specialist - job 1 of 2

As a Remote Claims CSR Specialist at TEKsystems, you will engage with customers directly, providing timely and accurate claim information. You'll solicit necessary details to process claims and document interactions in our claim system with a focus on clarity. Other key responsibilities include processing incoming claims and reviewing appeals while ensuring compliance with operational standards. By meeting call center metrics, you play a vital role in enhancing customer satisfaction.

To qualify for the Remote Claims CSR Specialist position at TEKsystems, candidates should have health insurance or medical claims experience, along with familiarity with HFCA 1500 and UB04 forms. A minimum of one year of call center or office-based customer service experience is essential. Additionally, proficiency in MS Office applications and a high school diploma or GED are required to excel in this role.

The pay range for a Remote Claims CSR Specialist at TEKsystems is between $18.00 and $20.00 per hour, depending on your related experience. We also offer a weekly pay cycle, so you can enjoy the benefits of a well-timed paycheck while contributing to our success!

Yes! The Remote Claims CSR Specialist position at TEKsystems is a fully remote job. All necessary equipment will be provided, and you will just need to ensure you have a reliable internet connection and a quiet workspace to engage with our customers effectively.

At TEKsystems, a Remote Claims CSR Specialist can look forward to a comprehensive benefits package, including medical, dental, and vision insurance, a 401(k) retirement plan, life insurance options, and short- and long-term disability cover. Other perks, such as a Health Spending Account, transportation benefits, and Employee Assistance Programs, will support both your professional and personal well-being.

To ensure accuracy in processing claims, I employ a combination of attention to detail and organization. I triple-check the information entered, familiarize myself with claim forms like HFCA 1500 and UB04, and follow established protocols to reduce errors. Additionally, I always seek clarification if I'm ever uncertain about the data I’m processing.

Handling difficult customers requires patience and empathy. I actively listen to their concerns, validate their feelings, and communicate clearly about how I can assist them. By remaining calm and focused, I aim to resolve their issues efficiently, turning a challenging interaction into a positive experience.

I have a solid foundation in medical claims processing and compliance as it pertains to federal regulations and company policies. I stay updated on industry standards and always double-check for compliance patterns, especially when handling sensitive information or appeal requests.

In a remote setting, I rely on tools such as project management software, time-tracking applications, and communication platforms to stay organized and efficient. I also maintain a detailed planner to track my daily tasks and deadlines, ensuring that I meet all call center standards.

When dealing with multiple claims, I prioritize based on urgency and the complexity of each case. I assess which claims require immediate attention versus those I can handle later and manage my time accordingly. This method helps me maintain productivity and meet key metrics effectively.

The most rewarding aspect of working in claims processing is the ability to help people navigate their insurance challenges. Knowing that I can provide timely information that eases their stress or contributes to their well-being is immensely gratifying.

To maintain a positive attitude during high call volumes, I focus on one interaction at a time and remind myself of the importance of my role. Taking short breaks between calls to recharge also helps, and I use positive affirmations to stay motivated and engaged.

If I encounter a question I don’t have an immediate answer to, I first acknowledge the customer's inquiry and assure them I'm dedicated to finding the right information. I then consult available resources or escalate the issue to a supervisor to provide accurate and timely feedback.

In a situation where two claims contradict, I would thoroughly review both claims to identify discrepancies. Effective communication with the involved parties and possibly gathering additional information could clarify the situation. My goal is to resolve inconsistencies while upholding compliance and customer satisfaction.

The HFCA 1500 and UB04 forms are essential documents in medical claims processing. The HFCA 1500 is primarily used for outpatient claims, while UB04 is used for institutional claims such as hospitals. Understanding these forms allows me to accurately process and ensure claims are submitted correctly, which directly impacts reimbursement.