Infinite Computer Solutions
The Customer Support Agent will be responsible for handling US health insurance claims from healthcare providers or their authorized representatives. The Agent will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines.
Key Responsibilities
Handles claims related to providers: benefits, eligibility, claim status, and claims adjudication.
Researchs claims and provides explanation of benefits (EOB).
Utilizes internal systems and tools (via secure access methods) to retrieve and update information.
Documents all daily tasks related to claims adjudicated in the system.
Escalates unresolved cases to the appropriate internal departments.
Communicates clearly, concisely, and professionally with customers.
Adheres to all privacy laws and regulatory compliance requirements related to CMS and HIPAA.
Meets performance targets and service level agreements (SLAs).
Required Qualifications
High school diploma or equivalent (mandatory).
Some college education or a completed degree (preferred).
Strong command of the English language (verbal and written).
Basic knowledge of Windows OS and Microsoft Office tools.
Required Experience
2–5 years of Claims Adjudication (preferably in healthcare or insurance).
Experience working in an office environment with US healthcare background.
Familiarity with claims processing systems and provider portals (preferred).
Experience on Medicare plans, especially on I‑SNP, will be an added advantage.
Clear knowledge of different types of facilities in US healthcare like SNF, NF, etc.
Behavioral Attributes
Empathy: Understands and acknowledges provider concerns.
Professionalism: Maintains a calm and respectful tone under pressure.
Accountability: Takes ownership of responsibilities and outcomes.
Adaptability: Flexible with process changes and system updates.
Confidentiality: Complies with data privacy standards and regulations.
Competency
Excellent Communication: Ability to articulate clearly and listen actively.
Problem Solving: Uses logic and reasoning to resolve issues effectively.
Technical Proficiency: Comfortable navigating multiple systems and platforms.
Time Management: Handles tasks efficiently while meeting deadlines.
Customer Centricity: Focused on delivering a positive provider experience.
Team Collaboration: Works well with others and contributes to team success.
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Key Responsibilities
Handles claims related to providers: benefits, eligibility, claim status, and claims adjudication.
Researchs claims and provides explanation of benefits (EOB).
Utilizes internal systems and tools (via secure access methods) to retrieve and update information.
Documents all daily tasks related to claims adjudicated in the system.
Escalates unresolved cases to the appropriate internal departments.
Communicates clearly, concisely, and professionally with customers.
Adheres to all privacy laws and regulatory compliance requirements related to CMS and HIPAA.
Meets performance targets and service level agreements (SLAs).
Required Qualifications
High school diploma or equivalent (mandatory).
Some college education or a completed degree (preferred).
Strong command of the English language (verbal and written).
Basic knowledge of Windows OS and Microsoft Office tools.
Required Experience
2–5 years of Claims Adjudication (preferably in healthcare or insurance).
Experience working in an office environment with US healthcare background.
Familiarity with claims processing systems and provider portals (preferred).
Experience on Medicare plans, especially on I‑SNP, will be an added advantage.
Clear knowledge of different types of facilities in US healthcare like SNF, NF, etc.
Behavioral Attributes
Empathy: Understands and acknowledges provider concerns.
Professionalism: Maintains a calm and respectful tone under pressure.
Accountability: Takes ownership of responsibilities and outcomes.
Adaptability: Flexible with process changes and system updates.
Confidentiality: Complies with data privacy standards and regulations.
Competency
Excellent Communication: Ability to articulate clearly and listen actively.
Problem Solving: Uses logic and reasoning to resolve issues effectively.
Technical Proficiency: Comfortable navigating multiple systems and platforms.
Time Management: Handles tasks efficiently while meeting deadlines.
Customer Centricity: Focused on delivering a positive provider experience.
Team Collaboration: Works well with others and contributes to team success.
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