Operations Coordinator:

Inova Team is looking for a highly organized and proactive candidate to fill the role of Operations Coordinator. This individual will be responsible for overseeing customer service, claims processing, and provider recruitment and relations, ensuring alignment with the company’s service level standards. The ideal candidate should possess strong organizational skills, the ability to adapt to shifting priorities, and a flexible mindset to rotate between different operational functions as needed, ensuring productivity and efficiency.

Duties/Responsibilities:

Customer Service

• Provide quality customer service telephonically and proper documentation via the platform concerning appointments, benefits, and claims concerns
• Properly document and update call and complaint logs as well as generate activity reports routinely.
• Handle inbound and outbound customer service-related calls for members and health care providers.
• Entry of all customer service-related information into the company’s CRM tools.
• Processing and management of all provider and member non-voice inquiries (post, email, and fax).
• Transfer of select inquiries to the appropriate person or department as indicated by management.
• Properly document and update call and complaint logs, as well as generate activity reports on a daily, weekly, monthly, quarterly, and annual basis.
• Perform authorizations for simple outpatient, dental, and health care screening benefits based on coverage and member eligibility.
• Coordination of members’ health care needs (according to the benefit plan) domestically and regionally through the appropriate counterparts.
• Adhere to all policies and procedures that apply to each market.

Provider Recruitment and Relations

• Attend provider recruitment meetings and presentations as required.
• Ensures that provider contacts and supporting documents are submitted on time.
• Manage provider service projects as needed and ensure that deadlines are met.
• Prepare various reports including regular updates on recruitment and service projects, as directed by Management.

Claim Analysis

• Retrieval of claims to and from registered mailing locations.
• Claims processing and analysis of all claims.
• Compile, verify, interpret, analyze, and summarize claim data and preparation of client payment reports.
• Investigating potentially fraudulent claims.
• Review and obtain necessary approval of documents from policyholders and providers.
• Identify and resolve claim-related inquiries and issues.

Adaptation of Responsibilities Based on Business Requirements in Cases of Limited Transaction

• In the event of limited or no transactions, the Operations Coordinator may be assigned additional responsibilities to support the team's ongoing needs.

• At least 1 year of experience healthcare
• Experience in customer service, including voice and non-voice channels, showcasing strong communication, problem-solving, and active listening skills.
• Excellent interpersonal communication skills with a strong focus on active listening and service orientation.
• Maintains a professional demeanor and exhibits a positive attitude toward colleagues and customers.
• Proven ability to work effectively both independently and as part of a team.