Claims Call Center Representative - Public Consulting Group - Augusta, ME

Scope of Work : Claims Call Center Representatives are expected to answer provider calls, based on assignment, and take all appropriate follow-up actions, including, but not limited to, educating on claim status, claims resubmission and appeal protocol and documentation of caller escalations Responsibilities : • Educate caller on Medical claims status; • Provide caller with appropriate steps for claims resubmission; • Provider call with appropriate steps for submissions of claim appeals; • Access, read, and interpret medical claims elements; • Provide basic information to callers in regards to medical claims billing and submissions; • Assist callers with initial EDI form submission; • Learn, understand and use all screens within the EZ-CAP system; • Enter incidents within EZ-CAP call tracking system to inform other team members and relevant departments of changes, trends and escalations; • Refer callers to other ICS related departments such as the Member Services, Provider Services and PPI call centers; • Report all problems to the appropriate team leads and supervisors with recommend solutions; • Work as a team member with all other Claims staff; • Attend staff meetings and provide updates to the Supervisor or Team Lead on activities; • Other duties as necessary. Minimum Qualifications : • High school degree or GED and experience involving customer service relations; • Call Center experience; • Computer skills; • Knowledge of Microsoft Suite 2010 programs; • Ability to communicate effectively; • Ability to maintain confidentiality; EQUAL OPPORTUNITY POLICY STATEMENT 41 C.F.R. Section 60-741.44(a); 60-300.44(a) Public Consulting Group, Inc. complies with Section 503 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination by Federal government contractors and subcontractors against individuals on the basis of disability and requires affirmative action on behalf of qualified individuals with disabilities.

Public Consulting Group, Inc. also complies with the Vietnam Era Veterans Readjustment Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which prohibits employment discrimination against protected veterans by covered Federal contractors and subcontractors and requires each covered Federal contractor and subcontractor to take affirmative action to employ and advance in employment these veterans. If you have a disability or are a veteran covered by the program, please notify us by contacting a Human Resources representative.

Submission of this information is voluntary, and your refusal to provide it will not cause you to be subjected to harassment, intimidation, threats, coercion, or discrimination because you engage or may engage in any of the following activities: 1. Filing a complaint; 2. Assisting or participating in an investigation, compliance evaluation, hearing, or any other activity related to the administration of Section 503 or VEVRAA or any other Federal, state, or local law requiring equal opportunity for individuals with disabilities or protected veterans; 3. Opposing any act or practice made unlawful by Section 503 or VEVRAA or their implementing regulations or any other Federal, state, or local law requiring equal opportunity for protected veterans or individuals with disabilities; or 4.

Exercising any other right protected by VEVRAA or by Section 503 or their implementing regulations. EQUAL EMPLOYMENT OPPORTUNITY – AFFIRMATIVE ACTION POLICY Public Consulting Group, Inc. pledges full support to the Affirmative Action Program and policy of nondiscrimination and equal opportunity in compliance with Executive Order 11246, as amended, as well as applicable state and local laws, directives, and regulations. Public Consulting Group, Inc.

recruits, hires, trains, and promotes persons in all job titles without regard to race, color, religion, national origin, gender, gender identity, age, sexual orientation, disability, or protected veteran status. We ensure that hiring and promotion decisions are in accord with equal employment opportunity principles by imposing only requirements that are job related and do not have an adverse impact, and that other employment decisions further the principle of equal employment opportunity. Public Consulting Group, Inc. ensures that all personnel actions such as compensation, benefits, company-sponsored training, education, tuition assistance, transfer, demotion, termination, layoff, return from layoff, and social and recreational programs are administered without regard to protected group status.

Equal opportunity can only be achieved through demonstrated leadership and aggressive implementation of a viable Affirmative Action Program. Our Affirmative Action Program sets forth specific affirmative action and equal employment opportunity responsibilities of managers, supervisors, and all employees. It is incumbent that employees not discriminate in any policy, practice, or procedure on the basis of protected group status. All employees are expected to make every reasonable effort to carry out their Affirmative Action Program responsibilities in spirit, as well as in letter, to assure that equal opportunity is available to all.

We further expect all employees to demonstrate sensitivity to, and respect for, all other employees and to demonstrate commitment to the Company’s equal employment opportunity and affirmative action objectives. Administrative responsibility for this vital Affirmative Action Program, including regular monitoring and periodic reporting to top management, is delegated to EO Administrator Public Consulting Group, Inc.. This program is available for review upon request by any applicant or employee by contacting the EO Administrator during regular business hours. _______________________________________________ William S.

Mosakowski, President Public Consulting Group, LLC 3/24/14