380 Customer Service Representatives jobs in Boise
Client Services Team Lead
Posted 2 days ago
Job Viewed
Job Description
Client Servicing Team Leads are responsible for leading and managing a team of client servicing professionals, focused on maximizing employee engagement, and building a culture of teamwork, collaboration, continuous improvement, empowerment, and accountability. They lead from the front and provide guidance, support, and coaching to team members and contribute to strategic planning, hiring decisions, team structure, and succession planning.
They collaborate with cross-functional internal teams to identify areas for process optimization, implement best practices, and drive operational excellence within the Client Servicing division. They lead from the front by building and maintaining strong relationships with clients, playing a critical role in daily client success.
Responsibilities- Monitors the teams' delivery to the client, allocating work, ensuring quality delivery, and providing team level training or knowledge management where required.
- Owns the preparation and execution of regular 1-on-1s and biannual performance management reviews; identifies and facilitates learning and career growth opportunities for the team.
- Designs, implements, and tracks quantitative and qualitative metrics to measure the success of projects, people, and processes; key success metrics include NPS, CSAT, CEM, SLA delivery, Retention, ESS, Gross Margin, Client Churn, Automation improvements, and employee attrition.
- Leads SteerCos and client relationship reviews, whilst also acting as a confident, knowledgeable, and patient escalation point for any client issues.
- Helps build a differentiated offering by strategies with product management and development teams to improve our client offering, operational tooling, supporting sales efforts, develop repeatable and scalable processes.
- Ensures the seamless transition of newly onboarded clients into steady-state client servicing operations.
- Make use of tooling to monitor and drive team performance (Salesforce, Workday, Power BI, etc.).
- Familiarity with insurance and/or investment management market concepts a plus.
- Ability to communicate information clearly, concisely, and confidently in written and verbal contexts, including small and large group settings for both internal and external (client-facing) audiences.
- Microsoft Excel (VLookUp, SUMIF, Pivot Tables, VBA, etc.).
- Strong computer skills, including proficiency in Microsoft Office.
- Excellent attention to detail and strong documentation skills.
- Outstanding verbal and written communication skills.
- Strong organizational and interpersonal skills.
- Exceptional problem-solving abilities.
- Bachelor's degree in Accounting, Finance, Business, Mathematics, Sciences, or related field.
- 7+ years of directly applicable experience (reconciliation, accounting, or finance).
- 2+ years demonstrated success in a people manager role.
- Experience delivering measurable KPIs weekly and monthly in prior roles.
- Experience working in the finance or FinTech industry, with a knowledge of investment accounting or investment operations preferred.
Specialist, Prime Client Services

Posted 12 days ago
Job Viewed
Job Description
At Coinbase, our mission is to increase economic freedom in the world. It's a massive, ambitious opportunity that demands the best of us, every day, as we build the emerging onchain platform - and with it, the future global financial system.
To achieve our mission, we're seeking a very specific candidate. We want someone who is passionate about our mission and who believes in the power of crypto and blockchain technology to update the financial system. We want someone who is eager to leave their mark on the world, who relishes the pressure and privilege of working with high caliber colleagues, and who actively seeks feedback to keep leveling up. We want someone who will run towards, not away from, solving the company's hardest problems.
Our is intense and isn't for everyone. But if you want to build the future alongside others who excel in their disciplines and expect the same from you, there's no better place to be.
While many roles at Coinbase are remote-first, we are not remote-only. In-person participation is required throughout the year. Team and company-wide offsites are held multiple times annually to foster collaboration, connection, and alignment. Attendance is expected and fully supported.
As a Specialist, Prime Client Services you'll join a high performing team of client servicing professionals whose performance is critical to Coinbase achieving its mission. You will serve as a subject matter specialist for Coinbase's institutional suite of products (Prime, Custody), providing premier client service and operations to our most valued institutional clients and coverage teams. Diligent, insightful, and have a bias towards action, you will play a crucial role in the success of the *Institutional Operations Services* organization as we help build the crypto economy.
The role goes beyond being the face of Coinbase for our top tier clients as team members are also expected to have a high level of system, product and crypto expertise to ensure client queries are managed autonomously within our exceeds client expectations client model.
*What You'll Be Doing (i.e., Job Duties)*
* Act as a product and service expert for Coinbase's institutional clients, providing end-to-end support across their lifecycle on the platform.
* Navigate and execute complex workflows, including analytics, account maintenance, client management, incident and escalation management, billing, audit processes, reporting, allocations, cold storage, and wallet management.
* Deliver direct client service and support to institutional clients through phone, email, and video calls, ensuring queries are resolved with accuracy and professionalism.
* Facilitate client demo calls, serving as a subject matter expert for the Prime Broker suite of services, and address technical cryptocurrency-related questions.
* Operationalize new and existing policies, processes, and procedures, ensuring alignment with risk and control requirements.
* Support product launches by driving operational readiness and ensuring seamless integration for institutional clients.
* Serve as a key member of the global 24x7 operating model, balancing deep product expertise with high-touch client support.
* Collaborate with internal teams, including Sales, Account Management, Program Management, Engineering, and Product, to resolve issues, surface client feedback, and drive product enhancements.
* Lead or contribute to cross-functional projects with alignment to organizational OKRs, leveraging effective project management skills.
* Identify gaps in processes, policies, or tools, and recommend or implement improvements to enhance client service delivery.
*What We Look For In You (Requirements):*
* Passionate about Coinbase's mission, with a focus on delivering exceptional client servicing experiences while maintaining operational risk and control standards.
* 4+ years of experience supporting high-priority institutional clients in compliance, trading, product support, payments, or fraud.
* Strong knowledge of cryptocurrency, global financial markets, and trading platforms, with the ability to turn technical concepts into actionable solutions.
* Proven ability to manage high-stakes interactions and resolve complex technical and operational issues under pressure.
* Excellent communication skills for effective collaboration across teams and with clients.
* Flexibility to work shifts, including weekends, in a dynamic 24/7 environment.
*Nice to Have (Preferred Qualifications):*
* Bachelor's degree in Finance, Business, Economics, or a related field preferred.
* Work experience in customer support roles focused on Institutional Client Services or High Net Worth Individuals (HNWIs).
* Industry experience within Traditional Finance, Crypto, or Fintech.
* Familiarity with financial technologies like digital banking, trading platforms, or payment solutions.
* Hands-on experience with complex financial products or crypto custody solutions in regulated environments.
* Located in or able to work Eastern or Central Time Zone hours.
Job #: P71800
#LI-Remote
*Pay Transparency Notice:* Depending on your work location, the target annual salary for this position can range as detailed below. Full time offers from Coinbase also include target bonus + target equity + benefits (including medical, dental, vision and 401(k)).
Pay Range:
$45.68-$53.75 USD
Please be advised that each candidate may submit a maximum of four applications within any 30-day period. We encourage you to carefully evaluate how your skills and interests align with Coinbase's roles before applying.
Commitment to Equal Opportunity
Coinbase is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, sex, gender expression or identity, sexual orientation or any other basis protected by applicable law. Coinbase will also consider for employment qualified applicants with criminal histories in a manner consistent with applicable federal, state and local law. For US applicants, you may view the in certain locations, as required by law.
Coinbase is also committed to providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation because of a disability for any part of the employment process, please contact us at accommodations Data Privacy Notice for Job Candidates and Applicants
Depending on your location, the General Data Protection Regulation (GDPR) and California Consumer Privacy Act (CCPA) may regulate the way we manage the data of job applicants. Our full notice outlining how data will be processed as part of the application procedure for applicable locations is available Disclosure
For select roles, Coinbase is piloting an AI tool based on machine learning technologies to conduct initial screening interviews to qualified applicants. The tool simulates realistic interview scenarios and engages in dynamic conversation. A human recruiter will review your interview responses, provided in the form of a voice recording and/or transcript, to assess them against the qualifications and characteristics outlined in the job description.
For select roles, Coinbase is also piloting an AI interview intelligence platform to transcribe and summarize interview notes, allowing our interviewers to fully focus on you as the candidate.
*The above pilots are for testing purposes and Coinbase will not use AI to make decisions impacting employment*. To request a reasonable accommodation due to disability, please contact accommodations(at)coinbase.com
Specialist, Prime Client Services
Posted 4 days ago
Job Viewed
Job Description
Ready to be pushed beyond what you think you’re capable of?
At Coinbase, our mission is to increase economic freedom in the world. It’s a massive, ambitious opportunity that demands the best of us, every day, as we build the emerging onchain platform — and with it, the future global financial system.
To achieve our mission, we’re seeking a very specific candidate. We want someone who is passionate about our mission and who believes in the power of crypto and blockchain technology to update the financial system. We want someone who is eager to leave their mark on the world, who relishes the pressure and privilege of working with high caliber colleagues, and who actively seeks feedback to keep leveling up. We want someone who will run towards, not away from, solving the company’s hardest problems.
Our work culture is intense and isn’t for everyone. But if you want to build the future alongside others who excel in their disciplines and expect the same from you, there’s no better place to be.
While many roles at Coinbase are remote-first, we are not remote-only. In-person participation is required throughout the year. Team and company-wide offsites are held multiple times annually to foster collaboration, connection, and alignment. Attendance is expected and fully supported.
As a Specialist, Prime Client Services you’ll join a high performing team of client servicing professionals whose performance is critical to Coinbase achieving its mission. You will serve as a subject matter specialist for Coinbase’s institutional suite of products (Prime, Custody), providing premier client service and operations to our most valued institutional clients and coverage teams. Diligent, insightful, and have a bias towards action, you will play a crucial role in the success of the Institutional Operations Services organization as we help build the crypto economy.
The role goes beyond being the face of Coinbase for our top tier clients as team members are also expected to have a high level of system, product and crypto expertise to ensure client queries are managed autonomously within our exceeds client expectations client model.
What You'll Be Doing (i.e., Job Duties)
-
Act as a product and service expert for Coinbase’s institutional clients, providing end-to-end support across their lifecycle on the platform.
-
Navigate and execute complex workflows, including analytics, account maintenance, client management, incident and escalation management, billing, audit processes, reporting, allocations, cold storage, and wallet management.
-
Deliver direct client service and support to institutional clients through phone, email, and video calls, ensuring queries are resolved with accuracy and professionalism.
-
Facilitate client demo calls, serving as a subject matter expert for the Prime Broker suite of services, and address technical cryptocurrency-related questions.
-
Operationalize new and existing policies, processes, and procedures, ensuring alignment with risk and control requirements.
-
Support product launches by driving operational readiness and ensuring seamless integration for institutional clients.
-
Serve as a key member of the global 24x7 operating model, balancing deep product expertise with high-touch client support.
-
Collaborate with internal teams, including Sales, Account Management, Program Management, Engineering, and Product, to resolve issues, surface client feedback, and drive product enhancements.
-
Lead or contribute to cross-functional projects with alignment to organizational OKRs, leveraging effective project management skills.
-
Identify gaps in processes, policies, or tools, and recommend or implement improvements to enhance client service delivery.
What We Look For In You (Requirements):
-
Passionate about Coinbase’s mission, with a focus on delivering exceptional client servicing experiences while maintaining operational risk and control standards.
-
4+ years of experience supporting high-priority institutional clients in compliance, trading, product support, payments, or fraud.
-
Strong knowledge of cryptocurrency, global financial markets, and trading platforms, with the ability to turn technical concepts into actionable solutions.
-
Proven ability to manage high-stakes interactions and resolve complex technical and operational issues under pressure.
-
Excellent communication skills for effective collaboration across teams and with clients.
-
Flexibility to work shifts, including weekends, in a dynamic 24/7 environment.
Nice to Have (Preferred Qualifications):
-
Bachelor’s degree in Finance, Business, Economics, or a related field preferred.
-
Work experience in customer support roles focused on Institutional Client Services or High Net Worth Individuals (HNWIs).
-
Industry experience within Traditional Finance, Crypto, or Fintech.
-
Familiarity with financial technologies like digital banking, trading platforms, or payment solutions.
-
Hands-on experience with complex financial products or crypto custody solutions in regulated environments.
-
Located in or able to work Eastern or Central Time Zone hours.
Job #: P71800
#LI-Remote
Pay Transparency Notice: Depending on your work location, the target annual salary for this position can range as detailed below. Full time offers from Coinbase also include target bonus + target equity + benefits (including medical, dental, vision and 401(k)).
Pay Range:
$45.68—$53.75 USD
Please be advised that each candidate may submit a maximum of four applications within any 30-day period. We encourage you to carefully evaluate how your skills and interests align with Coinbase's roles before applying.
Commitment to Equal Opportunity
Coinbase is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, sex, gender expression or identity, sexual orientation or any other basis protected by applicable law. Coinbase will also consider for employment qualified applicants with criminal histories in a manner consistent with applicable federal, state and local law. For US applicants, you may view the Employee Rights and the Know Your Rights notices by clicking on their corresponding links. Additionally, Coinbase participates in the E-Verify program in certain locations, as required by law.
Coinbase is also committed to providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation because of a disability for any part of the employment process, please contact us at accommodations(at)coinbase.com to let us know the nature of your request and your contact information. For quick access to screen reading technology compatible with this site click here to download a free compatible screen reader (free step by step tutorial can be found here).
Global Data Privacy Notice for Job Candidates and Applicants
Depending on your location, the General Data Protection Regulation (GDPR) and California Consumer Privacy Act (CCPA) may regulate the way we manage the data of job applicants. Our full notice outlining how data will be processed as part of the application procedure for applicable locations is available here. By submitting your application, you are agreeing to our use and processing of your data as required. For US applicants only, by submitting your application you are agreeing to arbitration of disputes as outlined here.
AI Disclosure
For select roles, Coinbase is piloting an AI tool based on machine learning technologies to conduct initial screening interviews to qualified applicants. The tool simulates realistic interview scenarios and engages in dynamic conversation. A human recruiter will review your interview responses, provided in the form of a voice recording and/or transcript, to assess them against the qualifications and characteristics outlined in the job description.
For select roles, Coinbase is also piloting an AI interview intelligence platform to transcribe and summarize interview notes, allowing our interviewers to fully focus on you as the candidate.
The above pilots are for testing purposes and Coinbase will not use AI to make decisions impacting employment . To request a reasonable accommodation due to disability, please contact accommodations(at)coinbase.com
Client Services SME - UR/Pharmacy
Posted 5 days ago
Job Viewed
Job Description
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Client Services SME - UR/Pharmacy
**PRIMARY PURPOSE** : To determine account management strategies related to client service plans; to be responsible for retention of existing clients, customer satisfaction, revenue growth, client surveys, and new business; to provide program management for jumbo clients requiring dedicated staff, multiple offices and complex service models; and to oversee the work of other local Client Services staff.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment a are driven to deliver great work.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Provides stewardship reporting to clients; identifying and educating clients on issues and trends impacting programs.
+ Conducts pre-renewal visits reviewing client loss experience and general company performance. Reviews and identifies areas of potential dissatisfaction prior to renewal meetings.
+ Performs client renewal, contract revision, and Client Service Instruction preparation for complex programs.
+ Negotiates changes or improvements to service plan.
+ Facilitates the reduction of process barriers, technology constraints, or resource constraints by directing and influencing the activities of other internal departments such as information technology, operations and business development.
+ Coordinates client invoicing, audits and accounts receivable follow up for assigned clients.
+ Resolves all major customer service issues.
+ Identifies and solicits cross-selling opportunities.
+ Participates in local insurance community through advanced education and affiliation memberships.
+ Supervises and directs personnel assigned to programs requiring multiple Account Representatives.
+ Ensures compliance with all applicable Quality initiatives.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travel as required.
**SUPERVISORY RESPONSIBILITIES**
+ Provides support, guidance, leadership and motivation to promote maximum performance.
+ Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
+ Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. CPCU, AIC and/or ARM or other related designation preferred.
**Experience**
Ten (10) years related experience or equivalent combination of education and experience required to include two (2) years account manager experience or five (5) years adjuster experience including two (2) years in a supervisory capacity.
**Skills & Knowledge**
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Excellent negotiation and facilitation skills
+ Leadership/management/motivational skills
+ Ability to work in a team environment
+ Excellent account rounding ability
+ Strong understanding of workers compensation, liability and disability claims management
+ In-depth knowledge of client servicing
+ Ability to handle conflict and confront challenging issues in a fast work environment
+ Ability to meet or exceed Performance Competencies
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $98,000-$105,000_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Call Center Representative
Posted 7 days ago
Job Viewed
Job Description
Kingdom Vision Builders is a quickly growing brand in the acrylic bath remodeling industry. We offer custom bath remodeling that enriches the lives of those we touch with bathrooms that are attractive, durable and maintenance-free. We are looking for a Call Center Representative for our Boise, ID office to join our winning team. Join our team of professionals and earn a substantial income, work for one of the fastest growing companies in the industry. Earn money while making a positive impact that help homeowners improve their homes.
General Purpose: Customer Service skills are a must. Contact homeowners by telephone, set up qualified appointments for free consultations. Input lead information, update reports and answer phone calls from ads.
Responsibilities:
- Deliver scripted pitch to the homeowners
- Adjust scripted pitch to meet needs of specific homeowners
- Handle homeowner's questions and objections
- Obtain homeowners information including names and addresses phone numbers etc.
- Receive appointments over the telephone
- Input appointment details into the computer system
- Input homeowners' information and important details of conversation
- Confirm appointments placed with canvassers or sales representative
- Issue appointments for reps to meet prospective homeowners
- Quality control phone calls
- Answer telephone calls from potential homeowners who are responding to advertisements
- Contact homeowners to follow up on initial interaction
- Update lead information and maintaining reports
Qualifications:
- Knowledge of sales and marketing principles and strategies
- Relevant work experience in telemarketing, sales, marketing, or promotions
- Product knowledge --Training provided
- Proficiency in relevant computer applications
We offer competitive compensation and ongoing professional development. Apply today to join our team!
Call Center Rehash Representative
Posted today
Job Viewed
Job Description
Kingdom Vision Builders is one of the fastest-growing brands in the acrylic bath remodeling industry. We specialize in custom bath remodels that enhance our customers' lives with beautiful, durable, and maintenance-free solutions.
We are currently seeking a Call Center Rehash Representative for our Boise, ID office. This role is dedicated to working the phones for follow-ups and reset appointments with homeowners who previously expressed interest in our services. This is an excellent opportunity to help homeowners move forward with their remodeling goals while building a rewarding career in a supportive, fast-paced environment.
Position Overview:As a Rehash Representative, you will be responsible for re-engaging potential customers, following up on previous leads, and rescheduling appointments when needed. You'll work closely with our sales and marketing teams to maximize every opportunity and help guide homeowners further down the path toward remodeling their bathrooms.
Key Responsibilities:- Make outbound calls to homeowners who previously inquired about our services but did not move forward
- Follow up on leads from past marketing efforts and consultations
- Reset and reschedule appointments as needed for sales representatives
- Use a provided script as a guide, while adjusting to each homeowner's needs and objections
- Maintain accurate records of all interactions and appointment changes in the CRM system
- Confirm previously scheduled appointments to ensure homeowner availability
- Handle inbound calls from homeowners looking to reschedule or requesting additional information
- Provide excellent customer service and represent the company with professionalism
- Work toward daily, weekly, and monthly performance goals
- Previous experience in call center, telemarketing, or inside sales preferred
- Excellent verbal communication and customer service skills
- Ability to handle objections and turn "not now" into a "yes"
- Strong organizational skills and attention to detail
- Comfortable using CRM or lead tracking systems (training provided)
- Self-motivated and goal-oriented
- Competitive hourly wage + performance-based bonuses
- Opportunities for advancement as we grow
- Paid training and ongoing professional development
- Supportive team environment
- Make a positive impact by helping homeowners improve their living spaces
Apply today to join the Kingdom Vision Builders team and play a key role in driving growth and helping customers rediscover the value of remodeling their homes!
Call Center | Patient Services Agent
Posted 2 days ago
Job Viewed
Job Description
Urgently hiring for experienced Patient Service Agents to join a rapidly growing organization in Meridian, ID that provides administrative support services to hospitals & medical clinics. What's in it for you? Elwood Staffing associates are eligible Patient Services, Agent, Call Center, Patient, Customer Service, Healthcare, Staffing
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Call Center Representative Jobs - Hiring Immediately
Posted today
Job Viewed
Job Description
We are currently looking for individuals to fulfill Part-Time and Full-Time Call Center Representative positions. No experience is required to apply for the position. Training is provided through former experienced employees and available to hired applicants. We are looking for individuals able to carry out various tasks. Individuals must be hardworking and task-oriented. Don't Wait! Fill out a Profile Now! MyJobResource is a staffing and recruitment industry job search engine. We specialize in finding the exact company to suit your needs. We help match job seekers to the right jobs in either full-time or temporary positions. Assignments are typically made depending on the ratio of candidates to jobs, skill-set, and experience. The companies we work with pay us for the services we provide to find the right people for their job openings.
Adjudicator, Provider Claims (LTSS Call Center)

Posted 12 days ago
Job Viewed
Job Description
**Job Summary**
The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.
**Knowledge/Skills/Abilities**
+ Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
+ This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.
+ Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
+ Assists in the reviews of state or federal complaints related to claims.
+ Supports the other team members with several internal departments to determine appropriate resolution of issues.
+ Researches tracers, adjustments, and re-submissions of claims.
+ Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
+ Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
+ Handles special projects as assigned.
+ Other duties as assigned.
Knowledgeable in systems utilized:
+ QNXT
+ Pega
+ Verint
+ Kronos
+ Microsoft Teams
+ Video Conferencing
+ Others as required by line of business or state
**Job Function**
Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.
**Job Qualifications**
**REQUIRED EDUCATION:**
Associate's Degree or equivalent combination of education and experience;
**REQUIRED EXPERIENCE:**
2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.
1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
**PREFERRED EDUCATION:**
Bachelor's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE:**
4 years customer service, claims, provider and investigation/research experience.
LTSS claims experience
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $38.37 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Adjudicator, Provider Claims (LTSS Call Center)

Posted 12 days ago
Job Viewed
Job Description
**Job Summary**
The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.
**Knowledge/Skills/Abilities**
+ Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
+ This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.
+ Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
+ Assists in the reviews of state or federal complaints related to claims.
+ Supports the other team members with several internal departments to determine appropriate resolution of issues.
+ Researches tracers, adjustments, and re-submissions of claims.
+ Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
+ Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
+ Handles special projects as assigned.
+ Other duties as assigned.
Knowledgeable in systems utilized:
+ QNXT
+ Pega
+ Verint
+ Kronos
+ Microsoft Teams
+ Video Conferencing
+ Others as required by line of business or state
**Job Function**
Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.
**Job Qualifications**
**REQUIRED EDUCATION:**
Associate's Degree or equivalent combination of education and experience;
**REQUIRED EXPERIENCE:**
2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.
1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
**PREFERRED EDUCATION:**
Bachelor's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE:**
4 years customer service, claims, provider and investigation/research experience.
LTSS claims experience
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $38.37 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.