Customer Service Rep

Claims Customer Service Representative JOB SUMMARY: Examine, perform, research and make the decisions necessary to properly adjudicate telephone and written inquiries. Interpret contract benefits in accordance with specific claims processing guidelines. Communicate problems identified relevant to the claims processing system to the appropriate people. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach. ESSENTIAL DUTIES & RESPONSIBILITIES (other duties may be assigned as necessary): Interpret contract benefits accurately to policyholder, agents, and providers with a positive and professional approach. Provide claim status to policyholders or providers with a positive and professional approach. Send out refund request letters and follow-up as necessary. Produce correspondence to customers. Answer calls as required by company policy in a helpful, professional, timely manner. Place outgoing calls as needed to provide or obtain information. Document (written/on-line) all calls while in progress. Transfer calls to employees in other departments as required to meet customer needs. Fully document policy file or imaging system with all related material so as to leave a clear and concise audit trail. Actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards. Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts. EDUCATION/EXPERIENCE: High School Diploma or GED equivalent Minimum of one (1) year related experience in a fast paced call center required. Experience in medical/insurance preferred. Experience with Medicare Supplement preferred.
Associated topics: call center associate, call center specialist, customer care representative, customer service associate, platform support, representante de servicio al cliente, service, support, technical support, telephone