Lead Customer Care Representative /TPA Liaison U-23
This position is specific only to Leads that support Third Party Administrators (TPA) in the specialized unit.
Resolves complex, difficult and/or non-routine submitted claims or customer service issues required by the TPA. May be assigned to take routine calls/process claims as needed. Interprets policy and contract eligibility.
Ensures that claims are settled satisfactorily and that favorable relationships are maintained
Advises and/or guides assigned department personnel in applying policies and procedures
Conducts client training on and off site and assigned department personnel as needed
Generates inventory reports for the TPA, Monitors claims aging reports and/or other multiple
reports for the TPA client
Participates in conference calls with clients and/or travels to the clients for meetings/trainings.
Generates and responds to daily emails from the TPA clients requiring assistance. Provides data to TPAs regarding Grievance & Appeals, Arbitrations/Depositions as needed
Supports Implementation Specialists
Supports Local and Enterprise Projects for the development of new system/product development
Generates access IDs/Passwords. Conducts UAT testing Performs quality review of work
performed by assigned department personnel
Monitors department audit results to ensure quality goals are being met.
Monitors department workflow to ensure production plans are being met
Contacts customers (i.e. providers, brokers, TPAs, and other Anthem departments) during the course of review to clarify and/or gather additional information required to process claims and/or resolve inquiries
Assists in development of improved workflow and methods
Prepares department reports and request ad hoc reports as needed. Provides direct support for all TPA business • Handles escalated issues as assigned
Responsible for resolution of HART team issues
Conducts legal research as requested by the Anthem legal department. Assists supervisor with day-to-day operations of the department
Two (2) years' experience as an Anthem Sr. Customer Service Representative or three (3) years' experience as an Anthem Customer Service Representative, and meeting expectations for quality and quantity. This position will support CSR'S assigned to telephones, and claims examiners.
