The Customer Relations Specialist focuses on delivering Delivers exceptional and personalized service and support to producers, providers and policy holders by responding to inquiries and questions, providing information,
This individual handle cases that have additional dependencies or complexity to ensure FCR.
Responsible handle resolution of complaints and escalated issues. Follows local complaints management regulatory requirements and ensures compliance.
Coordinates with other areas to resolve issues, concerns or complaints. Provides proactive follow up to open cases and complaint resolution.
Supports main contact center to resolve complex issues and prepare cases for the Customer Service Forum.
Supports in monitoring productivity and runs reports to determine volume of pending cases and requests
Assists team members with questions and problems related to policies, claims, departmental and company procedures. Provide feedback to the manager regarding training needed by the CS Team to ensure they reach a higher level of productivity and accuracy and adhere to company process, procedures and guidelines.
Handles escalated calls and emails from agents, providers and policy holders delivering exceptional personalized customer service.
Responds to all types of inquiries and questions regardless of issue including but not limited to new business application, policy changes, claims, commissions, payments, reimbursements, appeals, and complaints.
Reviews and analyzes documentation and cross reference systems to determine if claims have been correctly processed or if additional information or documentation is needed.
Point of contact for escalated calls or complaints.
Assist Team Manager and team members with escalated calls and emails or complex cases and issues in order to reach resolution for the agent or policy holder.
Proactively places calls and follows up with information or resolution within set deadlines ensuring customer satisfaction and anticipating future needs or problems before these arise.
Communicates and works with team members from various departments and providers to ensure issues are brought to resolution with set departmental guidelines.
Anticipates problems that could impede or delay resolution within acceptable service guidelines.
Documents all communication in the system to ensure notes are accessible for all team members.
Requests for additional documentation or information such as medical records to properly process a case.
Assist Team Manager with special projects and any assigned activities as required.
Ensures all contacts are conducted as expected for a positive customer experience; Responsible for providing a proactive follow up and complaint resolution.
Performs related tasks and projects as assigned.
4 years customer service or call center experience required preferably in insurance or health care industry.
Knowledge, Skills & Abilities :
Expert knowledge of company’s products, system and guidelines is required.
Knowledge of medical and insurance terminology, ICD9 and CPT codes, commonly used concepts, practices and procedures within the insurance field is required.
Basic computer skills required including MS Office Outlook, and Word in order to respond to emails and create correspondence.
Expert knowledge in company systems and procedures is required in order to, navigate and seek information, process policy changes, cross reference information and resolve complex problems, questions and issues.
Bilingual English / Spanish, / Portuguese a plus with the ability to read and write correspondence and verbally respond to inquiries and questions in both languages is required.