• Answering incoming telephone calls • Providing eligibility and claim information to medical providers and members • Reviewing and interpreting plan certificates to determine covered benefits and limitations/exclusions • Investigating claim payment issues • Researching PPO websites/database as required to determine if claims are received and processed by the PPO network • Documenting telephone call reason and details in claim system • Monitoring and answering voice mail • Reviewing inventory tool for status requests from providers/members and responding professionally • Initiating check inquiries (check tracers) from providers and members to determine if claim payment was received • Understanding HIPAA Regulations and Requirements as it relates to Personal Health information • Educating medical providers and members on new technology available to access plan information • Using probing skills to identify customer questions/concerns regarding plan coverage/benefits and providing single call resolution • Maintaining minimum call standards in accordance with company policy, industry standard & other applicable TPA or SLA agreements • Completing special projects as required or requested by management