Claim Reconsideration Specialist (Remote in Philadelphia) #35322
Office Call Center
PhiladelphiaPA Contract Oct 12, 2023
Contemporary Staffing Solutions is seeking a Claim Reconsideration Specialist to join our client for a remote opportunity (must be located in/near Philadelphia, PA)! This role is responsible for resolving provider claim reconsideration requests, addressing member billing complaints, and handling issues related to claim adjustment processing. This position requires effective communication via correspondence and telephone to ensure the satisfaction of our provider network. This Contract opportunity is offering $19.95/HR!

Key Responsibilities:
  • Respond to providers' inquiries, complaints, and problems with accurate and comprehensive information.
  • Collaborate with internal departments to facilitate the resolution of provider issues and concerns.
  • Provide courteous, professional, and efficient responses to provider calls, with timely follow-up to requests for information and service.
  • Address provider inquiries related to member eligibility, Third Party Liability (TPL), and benefits.
  • Document all interactions in compliance with departmental requirements.
  • Review claims in the core processing system and offer high-level claim status information in response to provider inquiries.
  • Furnish member authorization statuses upon request.
  • Educate providers on the capabilities of the Provider Portal, including password resets and duplicate Explanation of Payment (EOP) requests.
  • Assist the team in achieving and maintaining performance standards.
  • Operate telephone systems effectively and efficiently, following established protocols for security, transfer, and information exchange with Utilization Management, Pharmacy, and Claims Services departments.
  • Meet individual performance standards, including handling a satisfactory volume of calls and complying with telephone and paperwork audit procedures.
  • Maintain job-relevant resources, such as the provider manual and the department's training manual, to ensure accurate responses to provider inquiries.
  • Participate in ongoing projects, training, staff meetings, and committee meetings.
  • Perform any other necessary job duties.

  • High School Diploma.
  • General understanding of data entry processing.
  • One-year customer service experience.
  • Awareness of CPT-4, HCPCS, and ICD-9 coding schemes is a plus.
  • Proficiency in Microsoft Office.
  • Demonstrates clear and professional communication skills.
  • Contributes to a positive internal and external customer experience.
  • Identifies and resolves complex issues.
  • Adheres to all company policies and Standard Operating Procedures (SOPs).
  • Acts in accordance with the company's vision, mission, and values.

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: