Are you a person with customer service skills? Are you interested in working in a multilingual, dynamic and friendly environment that encourages personal and professional development?
We would love to meet you!
Office is located in Brickell, employee is expected to commute to the office.
From: $18.00 per hour **Hourly rate will take into consideration years of experience in a similar position and languages**
Position Purpose and Description
A customer service representative is responsible for assisting members and medical providers over the telephone and via email by providing information on members’ health plans. He/she will be required to validate the member’s policy, provide policy benefits and confirm a member’s eligibility. He/she will also be required to respond to inquiries regarding the status of authorizations and bills as well as assist members in locating appropriate medical providers. A customer service representative is expected to promote service excellence in all communications with members, providers and corporate clients.
A level one customer service representative is defined as being fully trained on all products and services provided by the Health Assistance Team, as indicated below.
During off-hours, in addition to the above, he/she will be responsible for responding to requests from corporate clients which can include; sending eligibility and benefit details to medical providers, providing bill status, arranging medical appointments and other services.
Expected Outcomes & Actions
1. Case and Call management: (75%)
a. Provide benefit and eligibility information on several insurance products to members and providers including the conditions and exclusions for each product;
b. Advise providers and members of services requiring prior authorization and the process to obtain authorization;
c. Obtain all necessary information to request authorization and open a claim following the appropriate guidelines;
d. Document all communications in the claims management system;
e. Provide members with referrals to in network providers; confirm providers network participation and validate billing details;
f. Respond to member inquiries on claim status including process date, payment amount, payment details, etc.;
g. Monitor team mailbox and respond to member, provider and client communication and follow up accordingly;
h. Coordinate medical appointments for members by liaising with the member and the appropriate medical provider
2. Administrative support: (15%)
a. Complete administrative tasks as delegated by the team leader and according to business needs, including, but not limited to triage, Go-Trex tasks, etc.
3. Off-hours additional tasks: (10%)
a. Respond to requests received from Corporate Clients during off-hours, subsequently adding the information to the claims system, following up on the clients’ requests, and sending confirmations and updates to the Corporate Client;
b. Monitoring urgent Case Management claims; taking the appropriate action and following up on authorizations; contacting Corporate Clients to request necessary information for Case Management claims;
Major Challenges
· Working with multiple systems;
· Staying current on systems, processes and products;
· Managing fluctuating call volumes;
· Remaining calm and professional in difficult situations.
Major Job Accountabilities
· Customer Experience – providing excellent customer service as per customer experience guidelines;
· Quality – opening quality claims according to claim opening guidelines;
· Efficiency – managing workload as per productivity guidelines i.e. average CHT, EHT, Task turnaround times, etc.;
· Adherence and Absenteeism – adhering to the work schedule.
KSA (Knowledge, Skills and Abilities/Attitudes)
· Superior customer service skills;
· Excellent interpersonal skills;
· High level of professionalism;
· Good problem-solving skills;
· Highly organized with ability to multi task and prioritize;
· Ability to handle stress
Requirements and Qualifications
· High School Diploma or equivalent;
· One to two years of experience in a customer service-related position;
· Clear and effective communication (written and verbal) in English. French and/or Spanish and/or German a plus.
· Proficiency in the Microsoft suite products.
Global Excel offers more than a position; we offer a professional future with a competitive compensation including base salary, performance bonus and benefits.
Job Type: Full-time
Pay: From $18.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Application Question(s):
- Does the Brickell office location works for you? (Please reply yes or no)
- Are you legally authorized to work in the U.S. on an on-going basis without sponsorship? (Please reply yes or no)
Language:
- Spanish (Preferred)
- French (Preferred)
- German (Preferred)
Work Location: In person