Customer Service Representative

Harris•Washington, DC

3d•Onsite

About The Position

eNoah, a Harris Computer company, is seeking a Life and Health Claims Customer Service Representative. In this position you will 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. 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. 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.

Requirements

Life and Health Claims experience
Ability to examine, perform research and make decisions necessary to properly adjudicate telephone and written inquiries.
Ability to interpret contract benefits in accordance with specific claims processing guidelines.
Ability to communicate problems identified relevant to the claims processing system to the appropriate people.
Ability to receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.
Ability to 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.
Ability to interpret contract benefits accurately to policyholder, agents, and providers with a positive and professional approach.
Ability to provide claim status to policyholders or providers with a positive and professional approach.
Ability to answer calls as required by company policy in a helpful, professional, timely manner.
Ability to place outgoing calls as needed to provide or obtain information.
Ability to document (written/on-line) all calls while in progress.
Ability to transfer calls to employees in other departments as required to meet customer needs.
Ability to fully document policy file or imaging system with all related material so as to leave a clear and concise audit trail.
Ability to actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards.
Ability to communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.

Responsibilities

Examine, perform research and make 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.
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.
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.