• Provide excellent customer service via phone to clients. • Maintain accurate customer service history notes regarding clients calls, changes to benefits, policies, etc., to allow efficient handling of future calls. • Assist with processing client requests received via mail, fax, and email. • Update and maintain customer records in the administration system. • Process and analyze new business transactions, policy transactions, and correct company records to adjust errors. • Mail specified forms and route completed forms for processing.

• Provide superior customer service to external and internal customers • Identify and resolve customer inquiries using active listening and critical thinking • Answers inbound phone inquiries timely and accurately • Provide tier one digital banking support and assist customers with debit card support • Process customer inquiries accurately and efficiently

• Serves as first point of escalation for questions and issues on the team • Use good judgment to inform and/or escalate to management as may be appropriate • Leverage knowledge and acumen in the medical billing and claims industry to provide actions-based solutions for clients, and answer staff questions • Assists in the gathering of information, data points, and current reporting tools to resolve any conflicts or concerns of claim discrepancies • Responsible for ensuring that regular data reporting from the team for internal business groups and for clients are delivered in accordance with schedule and scope • Coordinates and follows-up with audit groups to monitoring data flow coming from selection team • Inform appropriate management and audit team members as appropriate for delays or issues • Reviews incoming requests for Ad Hoc reports, from varying resources, and assessing the skills and capabilities of the team, assigns the creation of the report to the employees • Creates and delivers scheduled and ad-hoc reporting on-time and with high quality • Contributes to special ad hoc report creation and analysis to create effective resolutions for client requests, inventory monitoring and management, medical records request letters, and other time sensitive work product • Monitors claim and case inventory reports and utilizes industry knowledge and company procedures to effectively assign case inventories to meet daily, weekly, and monthly work product objectives • Requests insights drawn from DPE spreadsheet queries, working with excel filter tools, and knowledge of DPE reporting to extract and assign needed • Provides some basic analytic review in event of client escalates concerns on re-pricing initiatives or determinations, and the client seeks solutions from data reporting • Participates in weekly and monthly communication and service focused meetings both internally with staff and as a knowledge participant for client calls, building working relationships of trust and reliability with client(s) • Responsible for reporting meeting outcomes, minutes, and accomplishments applicable to the team • Responsible for the on-the-job training of staff on work processes and tasks, standard operating procedures, system proficiency, and changes as applicable based upon internal or client requirements • Contribute to the development and/or improvement and administration of team productivity and Quality Assurance metrics and procedures • Monitor activity volume and staff capacity to ensure resources are aligned with business needs • Provide insights to management as may be needed for staff or workflow planning • Review team and individual productivity and quality against established metrics and identify potential issues or gaps, making recommendations to applicable supervisor or management on performance improvement needs • Other Duties as assigned

• Provide professional, accurate and timely responses to CMS (Medicare) and provider inquiries. • Maintain a current knowledge of all contract requirements and objectives. • Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. • Take inbound calls from providers to answer questions and resolve complex issues. • Make outbound calls to healthcare providers to confirm if letters requesting records for review have been received. • Respond to assigned written communications from providers timely and accurately. • Educate providers on proper process protocols and their appeal rights. • Establish appropriate contacts and perform necessary research to validate provider contact information. • Enter and update all contact and activity information into tracking logs and the audit platform. • Research and route internal/external communications to the appropriate person or department. • Notify management of escalated displeasure, legal action, government intervention, or suggestions for process improvements.