Policy Administration Representative

AmeriLife•Remote, FL, WA

3d•Remote

About The Position

Senior Healthcare Direct is a leading Medicare and ancillary call center committed to providing exceptional customer experiences. We are seeking dedicated and passionate individuals to join our dynamic team as Policy Administration Representatives. The Policy Administration Representative is responsible for managing insurance applications throughout the policy lifecycle, from pending status through final status. This role ensures applications are processed accurately and efficiently while maintaining compliance with company procedures, carrier requirements, and regulatory guidelines. The representative works closely with internal teams, customers, medical providers and carriers to resolve issues, obtain missing information, and ensure timely policy issuance.

Requirements

Excellent communication skills, both verbal and written.
Strong problem-solving and critical thinking ability.
Empathetic and patient with the ability to handle challenging situations.
Customer-focused mindset with a dedication to delivering exceptional service.
Ability to multitask and work in a fast-paced environment.
High School Diploma or equivalent
Proficiency in using computer systems and software.
Reliable Internet Connection: Maintain a stable, high-speed internet connection sufficient to support required business systems, applications, and phone services.
System Accessibility & Security: Maintain the ability to securely access SHD systems, applications, and resources from the remote work environment and comply with all applicable information security, privacy, and data protection requirements.
Confidential Work Environment: Employees must be able to perform their job responsibilities in an environment that protects customer and company information and prevents unauthorized individuals from viewing, hearing, or accessing confidential information. Employees must maintain a suitable, professional workspace that is quiet, secure, and free from distractions during scheduled work hours.
Professional Workstation: Maintain a workspace that supports safe and effective performance of job responsibilities, including appropriate seating, desk space, lighting, and workstation setup.

Nice To Haves

Experience working with Medicare, health insurance, or similar products is a plus.
Call center experience
Previous experience in insurance operations, policy administration, or application processing preferred.
Ability to learn and understand complex concepts, practices, and procedures of the insurance industry.
Accuracy and attention to detail.
Superior time management and verbal communication skills.
Adept in working with many different groups of people, at different levels of the organization, to achieve common goals.
Capable of working on multiple projects simultaneously with limited supervision.
Dependable, providing good attendance and schedule adherence.
Work well with others during conversations, projects, meetings, and other collaborations (teamwork)
Proven ability to maintain good working relationships with coworkers, and internal, and external customers, as well as the ability to defuse irate callers and resolve difficult calls.

Responsibilities

Manage assigned customer cases and insurance applications from submission through final status, including Approved, Cancelled, or Declined, taking appropriate action to move each case toward resolution.
Review applications and case information for completeness, accuracy, and compliance with internal, carrier, and regulatory requirements.
Identify, research, and resolve application discrepancies, missing information, outstanding requirements, and other barriers that may prevent an application from reaching final status.
Monitor assigned cases and proactively complete required follow-up activities to ensure timely progression, escalating complex issues as needed to support resolution.
Communicate effectively with agents, internal teams, medical providers, carriers, and other appropriate parties to obtain required documentation, information, or clarification.
Utilize internal systems, carrier portals, web-based resources, and other available tools to research cases, obtain information, document activity, and maintain accurate policy status.
Maintain accurate, concise, and objective documentation of case activity, actions taken, requirements, communications, and outcomes within the designated systems.
Process applications and manage cases in accordance with company policies, carrier guidelines, regulatory requirements, and established procedures.
Provide accurate status updates, guidance, and clarification to internal partners and agents regarding application status, outstanding requirements, and appropriate next steps.
Maintain current knowledge of company processes, carrier requirements, products, systems, and procedures and apply that knowledge consistently as business needs and processes evolve.
Participate in required training, process updates, and continuous learning to support accuracy, efficiency, compliance, and successful case outcomes.