Customer Service Representative...

Job Description :

As a Third-Party Administrator for dozens of Healthcare Insurance companies located

overseas, the Customer Service Representative is responsible to handle Inbound

requests received via phone and email for “Expat”, “Destination” and “Travel” patients

whose medical services will take place either in the United States or the rest of the

world. Besides providing coverage details to medical Providers / insured Members,

coordinating cashless appointments worldwide, providing bill status information to

Providers, the CSR will work closely with the Case Management department on services

that require an authorization which include identifying services that must be pre-certified

and initiating the pre-authorization process. Last but not least, the CSR will be working

with Account Management for any bill related matters that need to be escalated.

Main daily responsibilities, but not limited to :

• Direct communications with Members, Providers, Corporate Clients via phone,

email and any type of communication.

and create appropriate tasks that will trigger proper workflow

applicable)

and take appropriate actions (initiate authorization, provide status on existing

ones and escalate any issues to Case Management)

locating and contacting several Providers who have the availability and suit the

Members preferences and accept our Guarantee of Payment for a cashless

experience

payment and that only the correct amounts are collected from the patient

(deductible, co-payments, etc.) Assignment of benefits

sometime other Providers, confirmation of participation of a specific Provider in

the network. Steer callers to in network facilities / providers to generate higher

revenue.

check number, discounts taken, etc. to Members, Corporate Clients and

Providers by making the necessary contacts.

and / or parties involved.

escalated issues that require supervisory intervention.

attention in order to avoid or resolve an existing problem.

will be dealt with in an effective and timely manner.

being dealt with. Multitask and prioritize

the supervisor / manager.

customers.

etc.). Redirect callers when necessary

contact, keep parties updated on steps and actions taken.

without sacrificing the quality of the service.

Requirements :

✓ Bilingual (English & Spanish)

✓ Must be detail-oriented 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 co-workers (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