Claims Customer Service Representative II (Remote)

Remote - FL, IL, IN and WI

AMA Insurance (AMAI) offers life, health and disability insurance at affordable and exclusive rates to help doctors achieve a healthy and secure financial future. AMAI is part of the American Medical Association (AMA), a nonprofit, and the nation's largest professional Association of physicians. We are a unifying voice and powerful ally for America's physicians, the patients they care for, and the promise of a healthier nation. To be part of the AMA is to be part of our Mission to promote the art and science of medicine and the betterment of public health.

At AMA, our mission to improve the health of the nation starts with our people. We foster an inclusive, people-first culture where every employee is empowered to perform at their best. Together, we advance meaningful change in health care and the communities we serve. We encourage and support professional development for our employees, and we are dedicated to social responsibility. We invite you to learn more about us and we look forward to getting to know you.

We have an opportunity for a remote Claims Customer Service Representative II our AMA Insurance team. This role will provide Claim Call Center services for all plans of coverage issues by AMA Insurance. Assist insured with claim problems by phone or written communication. Interact and correspond with Carriers to ensure quality claim service is delivered. Provide moderate sales service support, providing information on benefits, eligibility, plan provisions, and premium billing as needed. Engages callers to build and maintain a strong reputation and forge a lasting relationship. Achieves exceptional results for our customers and colleagues.

RESPONSIBILITIES:

Claims Customer Support & Issue Resolution

• Respond to all incoming phone calls related to claim status inquiry from insured and providers within established response time and quality standards.
• Log brief description of calls on CAMS and CAPS systems.
• Make outbound calls as needed to support returned checks and resolve claim inquiries.
• Refer claims that were improperly handled to AMAI Claim Supervisor for immediate attention.
• Fulfill claim form requests for plans not administered by AMA Insurance.
• Communicate with insurance carriers or service providers as needed in order to provide feedback on claims administered by carriers.
• Handle waiver of premium transactions, cancellations due to death and other claims related transactions.
• Update Contact management and customer sending surveys.

Operations & Sales Support

• Provide information regarding benefits, eligibility, plan provisions, premium billing, and certificate changes as needed.
• Process changes to Administration System, including personal and coverage information, sending documents to callers when needed.
• Support business operations through participation in special projects as assigned by the Customer Service Supervisor.
• Contribute to process improvements and operational efficiencies.
• Assist in documenting workflows and service processes to support consistency and quality.

May include other responsibilities as assigned

REQUIREMENTS:

• High school diploma or equivalent education required
• Minimum of 2+ years’ experience in life, health, or Medicare insurance required.
• Health or Life insurance license preferred.
• Demonstrated experience working in a high-volume customer service call center.
• Excellent telephone skills including proper telephone technique, multitasking skills and ability to control the call.
• In depth understanding of claim adjudication and benefits required.
• Demonstrated experience handling customer issues, including technical and financial related issues.
• Strong knowledge of insurance products, benefits administration, or third-party administration services preferred. Health insurance knowledge preferred.
• Excellent verbal and written communication skills with a high level of professionalism.
• High level proficiency with call center systems, telephony platforms, and personal computers.
• Advanced proficiency in Microsoft Office Suite (Word, Excel, Access, PowerPoint) and database systems.
• Ability to provide technical support for online tools, systems, and customer-facing platforms.
• Strong business process skills, including the ability to document, monitor, and improve workflows.
• Excellent planning, organization, and time management skills with the ability to manage multiple priorities in a fast-paced environment.
• Ability to build and maintain positive relationships with internal and external stakeholders.

This role is a non-exempt position and the hourly range for this position is $23.63 - $30.83. This is the lowest to highest rate we believe we would pay for this role at the time of this posting. An employee’s pay within the salary range will be determined by a variety of factors including but not limited to business consideration, geographical location, as well as candidate qualifications, such as skills, education, and experience. Employees are also eligible to participate in an incentive plan. To learn more about the American Medical Association’s benefits offerings, please click here.

We are an equal opportunity employer, committed to diversity in our workforce. All qualified applicants will receive consideration for employment. As an EOE/AA employer, the American Medical Association will not discriminate in its employment practices due to an applicant’s race, color, religion, sex, age, national origin, sexual orientation, gender identity and veteran or disability status.

THE AMA IS COMMITTED TO IMPROVING THE HEALTH OF THE NATION