Lead Customer Care Representative /TPA Liaison U-23
Location: This is a remote position. The associate will be mapped to the Rancho Cordova, CA office. May need to commute to Rancho Cordova office for onboarding, training and/or meetings.
Wage Range: $32.48- $42.18/hr (Rancho Cordova, CA location)
*This position is specific only to Leads that support Third Party Administrators (TPA) in the specialized unit.
The Lead Customer Care Representative /TPA Liaison 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. This position will support CSR'S assigned to telephones, and claims examiners.
How you will make an impact:
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
Minimum Requirements:
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.
Preferred Skills, Capabilities and Experiences:
Strong Customer Service skills strongly preferred.
Advanced Written and Oral communication skills preferred.
JAA Claims experience preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $31.53 to $40.95
Locations: California
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
