Claims Specialist #34478
Office Call Center
PhiladelphiaPA Contract To Hire Jun 12, 2023
Claims Specialist 

Contemporary Staffing Solutions is seeking multiple Claims Specialists to join our client in Philadelphia, PA! The Claims Specialist is primarily responsible for the resolution of provider claim reconsideration requests, member billing complaints and related issues involving claim adjustment processing via correspondence and/or by telephone. This Contract-to-Possible Hire opportunity is offering $19.95/HR! 

Responsibilities of the Claims Specialist include:
  • Provide accurate and complete information in response to providers’ inquiries, complaints and/or problems.
  • Collaborate with internal departments to facilitate resolutions to provider issues and concerns
  • Respond to provider related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
  • Respond to provider inquiries regarding member eligibility, Third Party Liability (TPL) and benefits
  • Document all calls in accordance with departmental requirements
  • Review claims in the core processing system and provide high level claim status to provider inquiries
  • Provide member authorization statuses upon request
  • Educate providers on Provider Portal capabilities (i.e. reset passwords and duplicate EOP request)
  • Assist the unit in meeting and maintaining performance standards
  • Operate telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange with the Utilization Management, Pharmacy and Claims Services departments
  • Meet individual performance standards, such as satisfactory volume of calls, and telephone and paperwork audits.
  • Maintain resources relevant to the job, such as the provider manual and the department’s training manual to ensure accurate responses to provider inquiries
  • Participate in ongoing projects, training, staff and/or committee meetings
  • Perform other job duties as necessary.
Qualifications of the Claims Specialist include: 
  • High school diploma
  • General understanding of data entry processing
  • 1 year of customer service experience
  • Awareness of CPT-4, HCPCS, and ICD-9 coding schemes is a plus
  • Excellent verbal and written communication skills
  • Problem solving skills and attention to detail

Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: