Clerical Support Coordinator

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee a significant volume of incoming and outgoing calls from members and providers, as well as CRM-directed requests, emails, and digital submissions; verify account and eligibility information; and document all interactions and actions in compliance with internal quality standards.

• Enter, update, and confirm member, provider, and employer-group data across CRM and benefits administration platforms; maintain precise call logs and documentation.

• Verify eligibility, coverage levels, plan regulations, and benefit limits for members and providers; interpret plan documents to ascertain covered services.

• Assess claim adjudication results, clarify payment decisions, request claim modifications, and validate supporting documents such as EOBs, timely filing, and coordination of benefits.

• Address member and provider inquiries concerning benefits, claims, authorizations, billing, and participation in networks.

• Resolve issues utilizing internal knowledge bases and system tools.

• Act as a liaison between the contact center and claims, eligibility, provider relations, and medical management teams to address escalated concerns and ensure prompt follow-up.

• Maintain comprehensive records of all interactions, ensure HIPAA compliance, and adhere to established workflows and regulatory standards.

• Assist members and providers in navigating the online portal, mobile app, coverage verification tools, and digital resources.

• Conduct provider and network searches, assist with PPO and reference-based pricing networks, and guide callers in finding in-network facilities or verifying provider eligibility.

• Analyze incoming requests, prepare forms for scanning, and route items to the appropriate operational teams. Fulfill faxes as necessary.

• Generate routine reports, track service issues, document trends, and assist with operational audits or quality reviews.

• Complete all assigned tasks by the end of the day, meet productivity and quality metrics, and enhance the overall efficiency of the contact center.

• Identify process discrepancies, suggest improvements, and serve as a subject matter expert to facilitate team development and operational excellence.

⛳️ Requirements

• Minimum of 2 years experience in a call center within a TPA, health insurance, or employee benefits setting; experience in high-volume, multi-channel operations is preferred.

• Knowledge of group health plans, eligibility, benefits, and claims processes.

• Proficient in Microsoft Office (Word, Excel, Outlook) with the capability to quickly learn new systems, CRM tools, and workflows.

• Competent in entering and updating member/provider data, verifying information, and maintaining accurate documentation.

• Capable of multitasking, prioritizing, and managing workload efficiently.

• Able to identify issues, evaluate information, and apply suitable solutions.

• Comfortable adapting to changing processes, systems, and plan requirements.

• Works effectively with colleagues and cross-functional teams.

🏝️ Benefits

• Medical

• Dental

• Vision

• Life and Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• EAP

• Technology Stipend