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    • Ejecutivo de Servicio Junior Health - Monterrey - Willis Towers Watson

    Willis Towers Watson
    Willis Towers Watson Monterrey

    hace 2 semanas

    Default job background
    Inmobiliaria
    Descripción

    Descripción del Rol

    Buscamos un colega con experiencia en la atención de siniestros que brinde un acompañamiento personalizado a nuestros clientes en la asesoría, consultoría e intervención de todos aquellos siniestros en gastos médicos mayores y vida para atender clientes VIP, resolver situaciones de controversia médico-administrativas en el dictamen y siniestros de alta complejidad o especialidad en el trámite con el cliente y la aseguradora.

    Rol:

    • Trámite y gestión personalizada de siniestros VIP o de clientes o gente clave con las aseguradoras en gastos médicos mayores y vida.
    • Acompañamiento al cliente o con las áreas de recursos humanos en siniestros complejos o en controversia en el dictamen.
    • Revisión integral de condiciones generales y endosos de póliza con validación médico-administrativa, derechos o quejas de nuestros clientes para revisarlo con las aseguradoras.
    • Intervención directa con las áreas de siniestros de aseguradoras ante la problemática que se presente antes, durante y hasta el alta hospitalaria de nuestros clientes en los hospitales por pago directo.
    • Activación, acompañamiento y seguimiento con los clientes y las aseguradoras para agilizar las altas hospitalarias por causas de defunción y la liberación de cuerpos a los familiares del cliente.
    • Activación y seguimiento de servicios de home care y case management con aseguradoras.
    • Gestión de aplicación de beneficios de descuentos a nuestros clientes en siniestros no procedentes o rechazados por las aseguradoras en pago directo.
    • Apegamiento al modelo de excelencia operacional del front de siniestros con el registro en el benefits engine para trazabilidad e indicadores de gestión, garantizando la confidencialidad de la información.
    • Trámite y gestión de siniestros de pólizas de conversión con aseguradoras.
    • Trámite y gestión de siniestros de pólizas de vida con aseguradoras y el cliente y/o beneficiarios.
    • Apego al protocolo de la matriz de escalamiento del front de siniestros para la resolución de problemas o quejas del cliente.
    • Cumplimiento con las capacitaciones quincenales del ABC del front de siniestros de gastos médicos mayores y vida.
    • Participación en capacitaciones y actualizaciones de procesos de siniestros de las aseguradoras.
    • Cumplimiento de cursos mandatorios y opcionales asignados por WTW o el líder del front de siniestros.

    Requisitos

    Los Requerimientos:

    • Empatía, amabilidad, cordialidad, buen trato, buena escucha, actitud de servicio y capacidad para tratar con diferentes tipos de empleados y manejar situaciones de estrés.
    • Ser previsor y proactivo, anticipándose a las problemáticas en siniestros por falta de asesoría o revisión de la información proporcionada por el cliente.
    • Experiencia en trámite, asesoría y atención de siniestros en gastos médicos mayores y vida en brokers o aseguradoras.
    • Manejo intermedio de Microsoft Office (Excel, PowerPoint, Word).
    • El manejo del inglés (según necesidad del cliente) no es indispensable.
    • Disponibilidad para atender asuntos emergentes en horarios diversos.
    • Tolerancia al trabajo bajo presión y frustración.
    • Habilidad para manejar quejas, controversias y situaciones de presión.
    • Comunicación y escucha efectiva.

    Oportunidad de trabajo inclusiva

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