Customer Support Officer - Healthcare Insurance

Customer Support - HealthCare

Job Description

Job title Customer Support Officer Contact Center (Band 5, Level 2)

Reports to Unit Manager / Asst Unit Manager

Provides customer service support for third party administrators, Health Maintenance organizations, preferred provider organizations, managed care organizations and many more in US healthcare insurance market by identifying and updating information.

The ultimate motive is to ensure commendable service standards and maintain very high customer satisfaction.

Key Responsibilities:

• Agent would log on to the workstation and they log into the client application through his specific id and pull enrollment documents relating to the customer.
• The agent would make an outbound call to Payer to get missing information on the form.
• Once the forms are updated, they are sent back to processing team to complete the task and would be data verified by the QC member. There is also call monitoring done for all agents to ensure quality standards are met and feedback is given on a regular basis by QA and manager
• Staying current with knowledge of products/ processes & services offered by the client
• Ensure full adherence to all the quality parameters.
• Ensure 100 percent adherence to schedule.
• Meeting all defined targets like Productivity, quality, Maintenance of required reports in Excel.
• Responds to provider and member phone inquiries in a timely manner provides accurate responses in a professional and courteous manner
• Research inquiries using appropriate team members and Applications as resources
• Assists team with providing claim or Plan status for client inquiries
• Upon Customer request, modify or add details to the Medicare Advantage Plan in the Application.
  Follows up with provider and member calls to obtain further information internal departments may request, as needed
• Ensures that HIPAA guidelines are followed in every communication with providers, clients or staff.

Essential Job Functions:

• Look up for relevant information and update (type into) the client systems as per set procedures and policies.
• Attention to detail while accomplishing tasks, meeting Weekly / Daily targets with required quality in the given timelines
• Adhere to the team norms for making the overall team a cohesive one.
• Ability to prioritize and manage workload.
• Must be ready to work in night shifts

Behavioral Skills:

• Detail-oriented with ability to focus for extended periods
• Ability to work independently, seeking supervision as needed
• Ability to communicate professionally, clearly and effectively, verbally and in writing
• Ability to have superior attendance to effectively fulfill all functions of the position
• Ability to independently follow through on assigned tasks, without prompting
• Ability to prioritize effectively
• Ability to multitask
• Communicates clearly and concisely, with sensitivity to the needs of others
• Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
• Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issue
• Establishes and maintains effective working relationships with co-workers
• Follows all Policies and Procedures and HIPAA regulations
• Participates in any recommended or required training sessions
• Maintains a safe working environment

Qualification:

• Undergraduate (10+2)/Diploma / Graduate (Only Arts or Science) – Non-Technical Only
• Good communication skills.
• MIS experience – 1 years
• Advance excel minimum 1 year
• Excellent analytical, problem-solving, and communication skills.
• Detail-oriented with the ability to handle sensitive and confidential information.
• Ability to work independently and as part of a team.
• Strong organizational skills and ability to manage multiple priorities.
• Educational requirements include a High School Diploma or GED equivalent.
• Prior customer service experience is required (Inbound or Outbound Calls). Two years of professional work experience in a health plan call center is strongly preferred.
• Exposure to health plan management operations is preferred
• Knowledge in Medicare Plans preferred
• General knowledge of medical terminology preferred
• Knowledge and experience using current computer technology
• Working knowledge of Excel and Word.
• Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
• Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
• Ability to work independently with minimal supervision
• Ability to communicate professionally, clearly and effectively, verbally and in writing
• Ability to prioritize effectively
• Ability to multitask

Experience and Skills requirement for this role:

• Should be good with MS Office and reporting.
• Strong analytical and problem-solving skills
• Strong experience in MS office (MS Excel, Power point, Word etc)
• Minimum 1 year of voice experience
• Basic computer knowledge required
• Typing speed minimum 25-35 WPM with 85 percent accuracy
• Should be open to work in any shift (Monday – Friday) including US shift (9 PM IST to 7 AM IST)

Working Condition:

• Office-based environment with standard business hours.
• May require extended hours during peak periods or audits.
• Regular use of computer systems and phone communication.