Customer Service Representative

BEST DOCTORS INSURANCE SERVICES LLC•Miami, FL

About The Position

Serve as the direct representation of the company promoting the company’s level of service by evaluating, researching and answering all inquiries which include claims, products and benefits in a professional and concise manner. The Customer Service Specialist position is responsible for the management of the relationship with customers, agents and providers; maintaining the satisfaction according to the company standards.

Requirements

Good oral and written communication skills
Excellent Analytical skills
Detail oriented
Independent and self-motivated
Able to deliver excellent customer service, externally and internally.
Able to work under pressure
Team Player
Able to react effectively and calmly to emergencies
Ability to Multi-task
Computer literate with good keyboard skills.
Complete Fluency in English, Spanish and Portuguese
Good presentations skills, to a small or large audience
Skills to take ownership of a problem and help to create a solution
Associates Degree or higher
3+ years’ experience in Customer Service, dealing with very demanding clients in different countries.
Familiar with standard concepts, practices, and procedures of Health Insurance
Relies on experience and judgment to plan and accomplish goals
Excellent computer skills with proficiency in Microsoft Word, Excel, PowerPoint and Outlook.
Experience working within healthcare industry and claims
Experience working within a call center environment a plus

Responsibilities

Logs, tracks, and processes appeals and grievances
Handling and solving customer complaints regarding claims process and/or service which may be complex or long-standing and coordinating the solution with the participation of departments involved
Present appeals cases to the committee assigned and preparing communication of resolution to clients and agents
Contacts customers to gather information and communicate disposition of case
Conducts pertinent research in order to evaluate, respond to, and close appeals in accordance with all established regulatory guidelines
Entering payment information in the system and follow up on pending payments
Develops relationships with all levels of clients and achieve positive reviews about service and responsiveness.
Establishes productive, professional relationships with key administrative personnel in assigned agencies and agents providing training on claims guidelines, product information and portal system when necessary to ensure that the members experience Best Doctors’ highest standards of quality and care
Communicating courteously with customers by telephone, email, letter, live chat and face to face, supporting and answering any inquiry presented, related to operations, benefits and claims process.
Responding to customer inquiries professionally within the turnaround time established for the area, providing systematic follow-up and feedback to improve our service and process.
Coordinate and Participate on service calls with agents in weekly bases to address issues proactively, providing guidelines about our process.
Provides information and knowledge to the agents about the status of the claims and payments through weekly reports
Collaborates with sales and medical staff to resolve problems and develop service enhancements
Evaluating and Researching required information using accessible resources
Handle special projects and/or other related assignments as needed by service related issues
Identify escalating priority issues and report to supervisor when necessary
Recording details of comments, inquiries, complaints and actions and/or answers given in the appropriate system.
Work closely with all internal departments to request any information required to finalize a case
Ensure that customer information is kept confidential according to HIPAA guidelines.
Review checks daily to ensure payments are sent with the correct payment method chosen by members