Customer Service Representative I - Claims, Geisinger Health Plan (Pennsylvania resident)

• Determines if services received are covered benefits as applicable by line of business and product design. • Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products. • Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers. • Provides daily support and advice to member and provider services staff regarding claims issues. • Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.