Customer Service Representative - Kforce (Tampa, FL)

Job Responsibilities: Triages resulting rework to appropriate staff Explains member's rights and responsibilities in accordance with contract Assists in preparation of complaint trend reports Assists in compiling claim data for customer audits Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible Performs financial data maintenance as necessary Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received Source:

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