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.
Medicare Supplement Experience Needed
Customer Service Experience
ESSENTIAL DUTIES & RESPONSIBILITIES (other duties may be assigned as necessary, to include subrogation, Medicare adjustments, and 90 day follow-ups.):
Interpret contract benefits accurately to policyholder, agents, and 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.
High School Diploma or GED equivalent
Minimum of one (1) year related experience required. Customer Service, call center, fast-pace environment required.
Experience in medical/insurance preferred.
Experience with Medicare Supplement.
Insurance Administrative Solutions