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City:  Cincinnati
State:  OH
Job Requisition Number:  174250

Attention current TriHealth employees:

Please apply for this position by submitting an online internal application via SuccessFactors. Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.

Named to Truven Health's "Top 15" health system list, TriHealth, Inc. is the leading healthcare system in Greater Cincinnati, Ohio and is committed to be the most integrated health system in the market.  Our mission is to improve the health status of the people we serve and we are excited to make TriHealth an even greater place for people to work and for patients to receive care.  TriHealth is committed to ensuring that our strong values remain an integral part of who we are, what we stand for and what we believe in at our core.


At TriHealth, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets TriHealth apart. We see the big picture and do the right thing. That means a dedication to the well-being of both our colleagues and the patients they serve.



Customer Experience Representative role is responsible to answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs), ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems, and own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member.

Additional responsibilities include review and research incoming healthcare claims from members and providers(doctors, clinics, etc.) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits), ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates) and communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding.

Team members may be scheduled



EDUCATION: Bachelor's Degree Business

EXPERIENCE: 3-4 years Customer Service Healthcare Insurance, Healthcare Administration

SPECIALIZED KNOWLEDGE: In-depth knowledge of medical billing and coding In-depth knowledge of Medical Claims processing Knowledge of health insurance, HMO and managed care principles Critical thinking skills to build efficiencies To be able to focus on multiple projects .

Schedule: 7:30 a.m. until 4:00 p.m. Monday Through Friday


Department Name:  TPS CLAIMS ADMIN

Location:  Norwood


Employment Status: Full Time Position

Bi-Weekly Hours:80

Shift: Day Shift

Weekend Commitment:  No

Holiday Commitment:  No

On-Call Commitment:  No

Nearest Major Market: Cincinnati

Job Segment: Medical, HR, Customer Service Representative, Medicare, Healthcare Administration, Healthcare, Human Resources, Customer Service