Associate Customer Service

Job Description: Customer Service Representative is the face of our multinational client and impacts members'' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. Customer inquiries are of basic and at times complex nature. Engages, consults and educates members based upon the member''s unique needs, preferences and understanding of Clients insurance plans, tools and resources to help guide the members along a clear path to restore clients assets and personal belongings. Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. The guides the member through their members plan of benefits, Company''s policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines. Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members'' best solutions. Taking accountability to fully understand the member''s needs by building a trusting and caring relationship with the member. Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, insurance plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues. Explains client''s rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, reviews, complaints (member/provider), damages and appeals (member/provider) via target system. Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues. Responds to requests received from Client''s Law Document Center regarding litigation; lawsuits. Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines client necessity, applicable insurance coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. Handles incoming requests for inquiries, work schedules and claims. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.

Created: 2021-11-29