Career Opportunities

Customer Service Representative/Customer Service QA

The Customer Service Representative is responsible for responding to inquiries from subscribers and providers of health care services and for providing all information requested.  This position is also responsible for determining if claims are processed incorrectly and presenting any incorrect claims to the adjusters for correction.  The Customer Service Representative must have broad knowledge of all aspects of claims administration. 

Candidate must have a high school diploma or GED and at least one of the following:  At least one year customer service experience in a group health TPA, or at least two years customer service experience in a group health insurance company dealing with PPOs, or prior TriSurant experience with an “EE” performance rating on the most current performance review and with Dean Vaughn Medical Terminology Certification.  Candidate must have a good understanding of definitions of pre-existing conditions, deductibles, co-insurance and out of pocket maximums and know medical terminology well.  The position requires alpha-numeric data entry of at least 5,000 kph, excellent interpersonal, organizational, and oral/written communication skills, and working knowledge of claims processing functions, utilization review and case management functions, and provider networks.

The candidate must be able to understand and follow oral and written instructions well, and possess strong analytical skills.  The candidate must have the ability to enter data simultaneously while listening attentively, and must have demonstrated the ability to work pleasantly and effectively with others as a motivated, positive team player.    Preferences include two years customer service experience in a TPA/HMO or group health insurance company.  Preferences also include prior group health claims processing experience, "call center" experience, ICD-9 and CPT coding experience, and prior group dental claims processing experience and terminology. Submit your resume via email to HR@TriSurant.com or fax to 281-999-9545.