PRIMARY PURPOSE: To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to resolve issues with one call/one person response; and to direct calls to appropriate escalation path as needed.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims application and servicing processes.
- Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status.
- Educates claimants/callers on client requirements and benefit plans documenting all required details of the call in a concise professional manner.
- Enters verbal and written application information that meets both the internal and external customer’s requirements accurately into the claims management system.
- Assigns new claims to the appropriate claims handler.
- Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed.
- Attendance during scheduled work hours is required.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization’s quality program(s).
Education & Licensing
High school diploma or GED required. College courses preferred
One (1) year customer service experience or equivalent combination of education and experience required. Inbound call center experience preferred.
Skills & Knowledge
- Knowledge of medical terminology
- Understanding of claims management
- Excellent oral and written communication skills
- PC literate, including Microsoft Office products
- Strong organizational skills
- Good interpersonal skills
- Ability to multi task in fast paced environment
- Ability to support multiple clients across communication channels and utilize multiple systems simultaneously
- Ability to work in a team environment and/or independently
- Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.