81 Customer Service Representatives jobs in Fort Valley

**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.

Responsibilities:

• Responsible for preparing the donor, donor area and equipment for the pheresis process.

• Prepares the autopheresis machine for the pheresis process.

• Monitors the donor and the pheresis process, responds to specific alarms or signals that may occur during the process.

• Disconnects the donor when the process is complete.

• Maintains alertness and awareness to any reaction donor may have during or after the pheresis process and notifies appropriate staff.

• Uses Personal Digital Assistant (PDA) to record incidents that occur during the pheresis process, such as machine alerts and alarms, volume variances and donor adverse events.

• Uses PDA to link equipment and soft goods used in the pheresis process to the appropriate donor.

• Alerts Group Leader or Supervisor of donor flow issues.

• Ensures the accurate recording of donor data in the electronic donor information management system as outlined in the Standard Operating Procedures (SOPs).

• Understands the policies and procedures associated with hyper immune programs at the center if applicable.

• Maintains clean efficient work environment, and ensures sufficient operating supplies and forms are available as needed. Follows all Health Safety & Environmental (HSE) and Occupational Safety and Health Administration (OSHA) policies and procedures. Promotes safety in all actions.

• Maintains confidentiality of all personnel, donor and center information.

• May be cross-trained in other areas to meet the needs of the business.

• Bilingual skills may be required, at the discretion of the organization, to meet the needs of the business.

• Perform job-related duties as assigned.

Qualifications:

• High school diploma or equivalent required

• Minimum of three (3) months’ work experience, preferably in medical or health provider environment or equivalent combination of education and experience

• Must be able to perform basic math calculations

Different qualifications or responsibilities may apply based on local legal and/or educational requirements. Refer to local job documentation where applicable.

Our Benefits

For more information on CSL Plasma benefits visit .

About CSL Plasma

CSL Plasma ( operates one of the world’s largest and most sophisticated plasma collection networks, with over 350 plasma collection centers in the U.S., Europe and China. Headquartered in Boca Raton, Florida, CSL Plasma is a subsidiary of CSL Behring ( , a global biotherapeutics business and a member of CSL. Plasma collected at CSL Plasma facilities is used by CSL Behring for the sole purpose of manufacturing lifesaving plasma-derived therapies for people in more than 100 countries. The parent company, CSL ( , headquartered in Melbourne, Australia, employs 32,000 people.

We want CSL to reflect the world around us

At CSL, Inclusion and Belonging is at the core of our mission and who we are. It fuels our innovation day in and day out. By celebrating our differences and creating a culture of curiosity and empathy, we are able to better understand and connect with our patients and donors, foster strong relationships with our stakeholders, and sustain a diverse workforce that will move our company and industry into the future. Learn more Inclusion and Belonging | CSL ( .

Do work that matters at CSL Plasma!

R-

CSL makes all employment decisions without regard to race, color, religion, national origin, ancestry, age, sex, gender, pregnancy, disability, marital status, sexual orientation, gender identity, genetic information, military status, protected veteran status (specifically status as a disabled veteran, recently separated veteran, armed forces service medal veteran, or active duty wartime or campaign badge veteran) or other classification protected by applicable US federal, state or local law. CSL complies with all applicable employment laws, including but not limited to Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act, the Fair Labor Standards Act, and the Immigration Reform and Control Act.

Responsibilities:
- Responsible for preparing the donor, donor area and equipment for the pheresis process.
- Prepares the autopheresis machine for the pheresis process.
- Monitors the donor and the pheresis process, responds to specific alarms or signals that may occur during the process.
- Disconnects the donor when the process is complete.
- Maintains alertness and awareness to any reaction donor may have during or after the pheresis process and notifies appropriate staff.
- Uses Personal Digital Assistant (PDA) to record incidents that occur during the pheresis process, such as machine alerts and alarms, volume variances and donor adverse events.
- Uses PDA to link equipment and soft goods used in the pheresis process to the appropriate donor.
- Alerts Group Leader or Supervisor of donor flow issues.
- Ensures the accurate recording of donor data in the electronic donor information management system as outlined in the Standard Operating Procedures (SOPs).
- Understands the policies and procedures associated with hyper immune programs at the center if applicable.
- Maintains clean efficient work environment, and ensures sufficient operating supplies and forms are available as needed. Follows all Health Safety & Environmental (HSE) and Occupational Safety and Health Administration (OSHA) policies and procedures. Promotes safety in all actions.
- Maintains confidentiality of all personnel, donor and center information.
- May be cross-trained in other areas to meet the needs of the business.
- Bilingual skills may be required, at the discretion of the organization, to meet the needs of the business.
- Perform job-related duties as assigned.
Qualifications:
- High school diploma or equivalent required
- Minimum of three (3) months' work experience, preferably in medical or health provider environment or equivalent combination of education and experience
- Must be able to perform basic math calculations
Different qualifications or responsibilities may apply based on local legal and/or educational requirements. Refer to local job documentation where applicable.
**Our Benefits**
For more information on CSL Plasma benefits visit .
**About CSL Plasma**
CSL Plasma ( operates one of the world's largest and most sophisticated plasma collection networks, with over 350 plasma collection centers in the U.S., Europe and China. Headquartered in Boca Raton, Florida, CSL Plasma is a subsidiary of CSL Behring ( , a global biotherapeutics business and a member of CSL. Plasma collected at CSL Plasma facilities is used by CSL Behring for the sole purpose of manufacturing lifesaving plasma-derived therapies for people in more than 100 countries. The parent company, CSL ( , headquartered in Melbourne, Australia, employs 32,000 people.
**We want CSL to reflect the world around us**
At CSL, Inclusion and Belonging is at the core of our mission and who we are. It fuels our innovation day in and day out. By celebrating our differences and creating a culture of curiosity and empathy, we are able to better understand and connect with our patients and donors, foster strong relationships with our stakeholders, and sustain a diverse workforce that will move our company and industry into the future. Learn more Inclusion and Belonging | CSL ( .
**Do work that matters at CSL Plasma!**
R-
CSL makes all employment decisions without regard to race, color, religion, national origin, ancestry, age, sex, gender, pregnancy, disability, marital status, sexual orientation, gender identity, genetic information, military status, protected veteran status (specifically status as a disabled veteran, recently separated veteran, armed forces service medal veteran, or active duty wartime or campaign badge veteran) or other classification protected by applicable US federal, state or local law. CSL complies with all applicable employment laws, including but not limited to Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act, the Fair Labor Standards Act, and the Immigration Reform and Control Act.

Description
Job Title: Customer Service Representative
**This position is fully remote, but candidate must reside within 50 miles of a Veterans Affairs Medical Center (VAMC)**
Zeiders is an industry leader in military and family support. Our company's reputation is based on providing top quality service with exceptional, dedicated employees. This approach has earned client confidence and repeat business from satisfied customers. Located in Woodbridge, VA, Zeiders' employees support clients worldwide in behavioral health, military family resiliency, work-life education programs, and related services. We seek individuals with strong passion for what we do and our commitment to quality service.
Summary - This is a contingent opportunity and would begin work upon the contract award.
The Veteran Experience Office (VEO) is part of the U.S. Department of Veteran Affairs and its purpose is to improve how Veterans, their families, caregivers, and survivors interact with the VA. The VEO Call Center connects callers to benefits (VHA), health care (VBA), and memorial services (National Cemetery) to provide efficiency and effectiveness across multiple VA programs.
The Customer Service Representative (CSR) provides front-line operational support to Veterans for the Veterans Experience Office's (VEO) Contact Center. The CSR assists Veterans by directing them to the proper resources to resolve questions, issues, and complaints. Information requests are received from a wide variety of individuals, primarily Veterans and their family members and/or representatives, and responses are coordinated from multiple channels (e.g., phone, email, webchat).
Essential Duties and Responsibilities
+ Provide comprehensive, empathetic and immediate support and assistance to Veterans by maintaining an in-depth knowledge and understanding of departments, services and federal regulations that facilitate access to entitled programs
+ Conduct service recovery or call de-escalation as appropriate
+ Use knowledge management tool to locate process or information needed to assist the customer
+ Respond to a high volume of inbound calls, emails, and webchats using established procedures and techniques (e.g., ask probing questions or repeat back what was said) to clarify what is needed
+ Select or recommend the appropriate VA service or department to handle a particular issue or question and provide a warm transfer call to the appropriate VA Specialist
+ Document call details, service requests, issues, follow-ups, etc., accurately and within the expected time frame
+ Maintain confidentiality of callers and protect sensitive information (personal data, medical data)
+ Establish and maintain effective communication and working relationships with VA employees, outside agencies, and the public
Supervisory Responsibilities
This position has no supervisory responsibilities.
Required Qualifications
+ Must be located within 50 miles of a Veterans Affairs Medical Center (VAMC).
+ High school diploma or GED.
+ At least six (6) months of customer service experience in a professional office-based environment (virtual or in-person).
+ Excellent written and oral communication skills.
+ Ability to work under pressure and handle stressful situations.
+ Strong technology skills, as well as ability to navigate multiple computer systems simultaneously.
+ Strong data entry/typing skills with a high degree of accuracy.
+ Ability to hardwire to high-speed internet (i.e., min 25 Mbps download and 10 Mbps upload, both without any delay) for technical setup.
+ Must have a work-at-home environment that is ergonomically sound, conducive to taking customer calls, quiet, and free from distraction.
Preferred Qualifications
+ Prior experience in a similar role with the VEO.
+ Experience working in a call center or contact center.
+ Experience working in a virtual environment.
+ Familiarity with the military and veteran community programs.
Other Requirements
+ Ability to successfully complete a pre-employment and government background investigation to include FBI fingerprints.
+ This position requires access to U.S. Government facilities and systems. U. S. Citizenship, a valid driver's license, transportation, and auto insurance are required.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
+ Ability to work both independently and as part of a team.
+ Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
+ Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
+ Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
+ Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
+ Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
+ Time Management - Effectively prioritizes tasks, manages workload, and meets deadlines while maintaining accuracy and quality of work.
Physical Demands: Must have a home office setup. Works in office areas. Sits, stands, bends, lifts, and moves intermittently during working hours. Uses computer, telephones, copiers, printers and other office equipment. The employee must occasionally lift and/or move up to 10 pounds. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work Environment: The noise level in the work environment is usually quiet. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Zeiders Enterprises, Inc. is an Equal Opportunity Employer
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights ( notice from the Department of Labor.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c))