Top 4876 Claim Resolution Representative Jobs

Member Service Representative
Champion Health Plan/ Champion Payer Solutions —Long Beach, CA
- From $22 an hour
- Weekends as needed
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Claims Representative
Seaview Insurance Company —Phoenix, AZ
- $55,000 - $75,000 a year
- 8 hour shift
- Hybrid work
- Background check
- Office
- Bachelor's degree
- Health savings account
- Disability insurance
Quick Apply
Customer Experience Representative II
Intigral Inc —Walton Hills, OH
- Full-time
- Mid-level
- High school diploma or GED
- Communication skills
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Claim Resolution Specialist, Personal Property
Liberty Mutual —St. Louis, MO
- $61,000 - $96,000 a year
- Urgently hiring
- Mid-level
- 3 years
- Analysis skills
- Relocation assistance
Billing/AR Representative - Remote
EYECARE SERVICES PARTNERS MANAGEMENT, LLC —Remote
- $19 - $25 an hour
- Full-time
- Remote
- Basic math
- Mid-level
- Windows
- Paid holidays
- Disability insurance
Quick Apply
Client Support Representative
EnableComp —Remote
- Full-time
- Remote
- Microsoft Outlook
- Computer literacy
- Mid-level
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Account Resolution Representative
Children's Wisconsin —West Allis, WI
- Full-time
- Remote
- Anatomy knowledge
- HIPAA
- Research
- Flexible schedule
Insurance Account Resolution Specialist - Digitech - Remote
Sarnova —Remote
- Full-time
- Remote
- Microsoft Outlook
- Research
- Mid-level
- 401(k)
Quick Apply
Patient Account Representative - Remote
Med-Metrix —Remote
- Full-time
- Remote
- Customer service
- Basic math
- HIPAA
Contact Center - CSR-1 - Customer Service Representative 1
Wellcove —Remote
- Full-time
- Remote
- Background check
- High school diploma or GED
- Typing
Quick Apply
9d
Healthcare Customer Service Representative
University of Colorado Medicine —Remote
- $22 - $25 an hour
- Full-time
- Remote
- Research
- Mid-level
- High school diploma or GED
- Health insurance
- Opportunities for advancement
9d
Customer Service Representative - Part Time (Remote)
GETIX HEALTH —Houston, TX
- $17 an hour
- Part-time
- Remote
- Spanish
- HIPAA
- English
Quick Apply
Enrollment Representative
GLOBALHEALTH HOLDINGS LLC —Oklahoma City, OK
- Full-time
- Remote
- Microsoft Excel
- Writing skills
- HIPAA
- Health insurance
Quick Apply
Remote Healthcare Customer Service Representative
Conduent Commercial Solutions, LLC —Remote
- $16 an hour
- Email
- Remote
- Background check
- Microsoft Outlook
- Computer literacy
- Paid training
- Paid holidays
Claims Customer Service Representative I
Partnership HealthPlan of California —Fairfield, CA
- $29.95 - $35.19 an hour
- Full-time
- Computer literacy
- Research
- High school diploma or GED
Collector
Cadex Solutions —Remote
- From $19.23 an hour
- 8 hour shift
- Writing skills
- Basic math
- High school diploma or GED
- Disability insurance
- Health insurance
Quick Apply
CBO AR Representative
MedSrv —Remote
- $18 an hour
- Full-time
- Remote
- Computer literacy
- Mid-level
- Communication skills
- Paid time off
- 401(k) matching
Quick Apply
9d
Supervisor Claims
Mutual of Omaha —Remote
- $75,500 - $97,000 a year
- Email
- Remote
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
- Paid holidays
- 401(k)
Account Resolution Representative Senior
Children's Wisconsin —West Allis, WI
- Full-time
- Bilingual
- Research
- Mid-level
Pharmacy Claims Representative 2 - Remote
Dragonfly Health —Arlington, TX
- From $22 an hour
- 12 hour shift
- Remote
- HIPAA
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply

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Member Service Representative

Champion Health Plan/ Champion Payer Solutions
Long Beach, CA

Quick Apply

Job Details

Full-time
From $22 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Flexible schedule

Qualifications

Spanish
Customer communication
Teamwork
Customer retention
Managed care
Managed care organization experience
Call center experience
HIPAA
English
Vietnamese
High school diploma or GED
Medical terminology

Full Job Description

SCOPE OF ROLE

The Member Service Representative (MSR) serves as the first point of contact for customers, providers, and advocates, ensuring exceptional customer experiences through accurate and helpful communication. This role involves handling incoming calls from Medicare Advantage members, assisting with benefit inquiries, referrals, claims, and guiding them to community resources as needed. The ideal candidate will be bilingual, proficient in medical terminology, and knowledgeable in CMS, Medicare, and HIPAA regulations. Strong proficiency in Microsoft Applications and a commitment to delivering top-tier service are essential.

ROLE RESPONSIBILITIES

The Member Service Representative job description is intended to point out major responsibilities within the role, but it is not limited to these functions:

KEY RESPONSIBILITIES % OF TIME

 Serve as the primary point of contact for customers, providers, and advocates, handling calls with professionalism and courtesy.

 Provide clear, concise, and accurate information to ensure customers fully understand their benefits, referrals, claims, and available resources.

 Ensure prompt and efficient service by answering all incoming calls within the

department’s established time frame.

 Escalate complex issues to management or relevant departments as necessary to

ensure customer concerns are thoroughly addressed.

 Collaborate with internal teams to resolve problems and enhance overall customer

satisfaction.

 Accurately document customer interactions, including actions taken, resolutions

provided, and any follow-up required.

 Adhere to department policies and HIPAA regulations to maintain confidentiality and

security of member information.

 Manage complaints, grievances, and appeals efficiently according to department

protocols.

 Assist in onboarding and training new staff, sharing knowledge and best practices.

 Complete required training promptly to stay current with procedures, systems, and

regulations.

 Consistently meet or exceed standards for quality, productivity, and adherence to

schedules.

 Participate in outbound call campaigns for welcome calls, enrollment verification calls, appointment scheduling,

retention efforts, and other health-related programs.

 Contribute to policy and procedure development related to customer experience.

 Stay updated on CMS, Medicare, and HIPAA regulations to ensure compliance and

provide accurate information.

 Utilize medical terminology and healthcare knowledge to assist members with inquiries.

 Adapt to changes in shifts, responsibilities, and operational needs as required.

 Facilitate member requests for provider changes, transportation, and other assistance.

 Maintain a positive attitude and practice excellent customer service principles.

 Perform other duties as assigned to contribute to the team and department’s success

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

 High School diploma or GED required.

 Associate degree (AA) degree (preferred).

 Minimum (2) or more years of direct customer service EXPERIENCE

 Knowledge of Medi-Cal, Medicare Managed Care Plans.

 Medical front office experience preferred.

PROFESSIONAL COMPETENCIES

 Strong communication skills (verbal and written).

 Highly organized with the ability to prioritize work to meet deadlines.

 Strong adaptability and openness to change.

 Knowledge of HIPAA regulations with a commitment to data privacy.

 Strategic skills in problem-solving, critical thinking, and innovation.

 Ability to collaborate effectively with business partners throughout the organization.

 Experience assisting members with Medicare Advantage or HMO, including referrals and authorizations.

 Outbound/inbound call center experience with a focus on problem-solving and escalation.

 Bilingual in English/Spanish or Vietnamese/English required.

 Proficiency in Microsoft Applications (Word, Excel, Outlook).

 Ability to multitask and prioritize tasks effectively.

 Flexibility to work varying shifts, including evenings and weekends.

LICENSURES AND CERTIFICATIONS

No licensures or certifications are required.

WORK ENVIRONMENT and ESSENTIAL PHYSICAL FUNCITONS:

Work Environment:

 Must be available for scheduling 7 days a week, including evenings, overnights, weekends, and holidays.

 Shifts may change based on operational needs; flexibility is essential.

Essential Physical Functions:

 Ability to work onsite in an open office setting, primarily sitting at a desk and working on a computer.

 Regularly required to talk, hear, stand, walk, sit, and use hands to handle or feel objects and controls.

 Frequently lifts/moves up to 10 pounds. Specific vision abilities include close vision and the ability to adjust focus.

EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse group of employees committed to meeting the needs of Champion Payer Solutions/ Champion Health Plan, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

401(k)
Dental insurance
Flexible schedule
Health insurance
Paid time off
Vision insurance

Experience:

Managed care: 2 years (Required)

Language:

Spanish (Preferred)
Vietnamese (Preferred)

Ability to Commute:

Long Beach, CA 90815 (Required)

Ability to Relocate:

Long Beach, CA 90815: Relocate before starting work (Preferred)

Work Location: In person

Quick Apply

Refine Your Search

Claim Resolution Representative jobs

Member Service Representative

Claims Representative

Customer Experience Representative II

Claim Resolution Specialist, Personal Property

Billing/AR Representative - Remote

Client Support Representative

Account Resolution Representative

Insurance Account Resolution Specialist - Digitech - Remote

Patient Account Representative - Remote

Contact Center - CSR-1 - Customer Service Representative 1

Healthcare Customer Service Representative

Customer Service Representative - Part Time (Remote)

Enrollment Representative

Remote Healthcare Customer Service Representative

Claims Customer Service Representative I

Collector

CBO AR Representative

Supervisor Claims

Account Resolution Representative Senior

Pharmacy Claims Representative 2 - Remote

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