Customer Service Representative - Ciudad de México - GLOBAL EXCEL MEXICO

GLOBAL EXCEL MEXICO

Empresa verificada

Ciudad de México

hace 16 horas

Publicado por:

Rodrigo Fernández

Reclutador de talento para beBee

Descripción

Job Purpose

Main daily responsibilities, but not limited to:

Register Policies in the system with proper eligibility, add Members/dependents and create appropriate tasks that will trigger proper workflow
Documentation of all calls or communications in the Members record (when applicable)
Confirmation of Benefits and Eligibility information to members and providers.
Identify medical services that require an authorization from the Corporate Client and take appropriate actions (initiate authorization, provide status on existing ones and escalate any issues to Case Management)
Coordination of medical services in/outside the USA, this, in most cases, include locating and contacting several Providers who have the availability and suit the Members preferences and accept our Guarantee of Payment for a cashless experience
Ensure that Providers send claims to the proper address for processing and/or payment and that only the correct amounts are collected from the patient (deductible, copayments, etc.) Assignment of benefits
Provide referrals to in network Providers to all Members, Corporate Clients and sometime other Providers, confirmation of participation of a specific Provider in the network. Steer callers to in network facilities/providers to generate higher revenue.
Provide claims information like status, process date, detailed payment amount, check number, discounts taken, etc. to Members, Corporate Clients and Providers by making the necessary contacts.
Assist on resolving any billing issue by contacting the appropriate department and/or parties involved.
Identify balance billing by analyzing claim and payment information available.
Identify potential problems and take prompt corrective actions in order to avoid escalated issues that require supervisory intervention.
Keep Account Managers informed of any delicate issue that may require their attention in order to avoid or resolve an existing problem.
Calm irate Members and Providers and reassure their problems and concerns will be dealt with in an effective and timely manner.
Make decisions on when a specific issue needs to be brought to the attention of the supervisor/manager.
Respond and address new business concerns from existing and potential customers.
Log and record all type communications for patient files.
Respond to general queries from members (policy procedures, reimbursements, etc.). Redirect callers when necessary
Follow up until completion on all issues that are not resolved on the initial contact, keep parties updated on steps and actions taken.
Service the maximum amount of callers in the quickest and most efficient way without sacrificing the quality of the service.

Requirements:

Bilingual (English & Spanish)
Must be detailoriented and organized
Must possess critical thinking skills as well as the ability to manage time efficiently.
Must be able to gather the information necessary to assist customers.
Always be sharp and alert.
Needs to communicate well with coworkers (verbal and written).
Knowledge of phone manners, etiquette and protocols.
Professional phone etiquette and written skills
Ability to adapt to changes
Able to understand, interpret and explain policies and procedures as well as knowledge of commonly used concepts, practices and procedures in the field.
Ability to deal with irate customers and complaints while maintaining composure and control of the situation.
Knowledge of Microsoft Office.
Ability to learn from past experiences.