Claims Customer Service Representative

Integrity Marketing Group•Clearwater, FL

2d•Onsite

About The Position

Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions to provide prompt, courteous customer service, which meets or exceeds service standards. Interpret contract benefits in accordance with specific claims processing guidelines. Primary Responsibilities other duties may be assigned as necessary : Interpret contract benefits accurately to policyholder, agents, and providers. Provide claim status to policyholders or providers. 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 problems identified relevant to the claims processing system to the appropriate people. 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. Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.

Requirements

A high school diploma or GED equivalent.
0-2 years of proven customer support experience; prior call center experience preferred
Strong phone contact handling skills and active listening
Familiarity with Microsoft Office products
Ability to adapt and respond to different types of people and tasks
Excellent communication and documentation skills
Ability to multi-task, prioritize, and manage time effectively and efficiently
Reliable transportation and the ability to be punctual and dependable
May have agent license but no active appointments

Nice To Haves

Insurance background preferred

Responsibilities

Interpret contract benefits accurately to policyholder, agents, and providers.
Provide claim status to policyholders or providers.
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 problems identified relevant to the claims processing system to the appropriate people.
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.
Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.