CUSTOMER SERVICE REPRESENTATIVE

The Customer Service Representative is responsible for performing all tasks relevant to in-house communications with the claimant's referral source, adjuster/examiner, case manager and physician’s office for verification of eligibility or coordination of benefits and services requested. The customer service staff coordinates set-up of pharmacy services.

Qualifications:

• High School Graduate, GED
• Home Health Aide (HHA) certification, Nursing Assistant certification, or Hospital Unit Clerk preferred, not required
• ·Data entry experience
• ·Excellent phone and customer related communication skills
• ·Ability to communicate clearly, both verbally and in writing
• ·Ability to multi-task to meet established deadlines
• ·Ability to prioritize work flow
• ·To work effectively with a wide range of people including referral sources, claimants, clients, physician offices, case managers, co-workers and management
• · Computer and typing skills
• · Adaptable to varied work environments with or without reasonable accommodation

Principal Duties and Responsibilities:

• ·Answer incoming pharmacy phone calls and input information according to auto no-fault/PIP/Workers’ Compensation criteria and diagnosis
• · Maintain open line of communication with claimants, care givers, case managers, adjusters/examiners, physician’s offices, hospitals and referral source,
• ·Respond to claimants’ questions and concerns.
• · Set-up of new claimant files, verifying eligibility information for full or coordination of benefits
• · Letter of Medical Necessity requests for physician involvement in ordering supplies or medications
• · Verify claimants address and telephone number for each delivery
• · Review order for completeness and accuracy before faxing order to Northwood provider for set-up
• · Surveys for new and current claimants
• · After hours on-call responsibilities
• · Other related duties assigned by the Program Manager/Assistant Program Manager
• Comply with all company information security policies and responsibilities as detailed during onboarding and annual security awareness training.

Northwood plays an integral role in health plan benefit administration for durable medical equipment, prosthetics, orthotics and medical supplies.

Northwood also serves auto and workers compensation clients and their PIP claimants.