Claims Customer Service Representative

Key Responsibilities

• Customer Service
• Handle high volume inbound customer inquiries via phone, ensuring prompt and professional service.
• Provide accurate and comprehensive information about insurance policies, benefits, and coverage.
• Resolve customer complaints and issues within a single call whenever possible, aiming for one call resolution.
• Claim Adjudication
• Demonstrate a thorough understanding of healthcare and other applicable insurance claim adjudication processes to accurately address and resolve policyholder inquiries and issues.
• Absorb and assist providers with claim(s) processing, including guidance for claim submission, clarifying reimbursement procedures, and ensuring compliance with Medicare and industry guidelines.
• Educate customers about the claim adjudication process and policy details.
• Daily Operations
• Maintain accurate and up-to-date records of customer interactions and transactions.
• Collaborate with other departments, including Medicare Supplement Claims Examiners, Ancillary Examiners, and other stakeholders to ensure seamless service delivery.
• Identify and escalate complex issues to the appropriate department for further resolution.
• Demonstrate Bankers Fidelity’s commitment to integrity, empathy, and professionalism in every customer interaction.
• Training and Development
• Stay informed about industry trends, CMS guidelines, and company policies related to Medicare Supplement and all other applicable insurance.

Qualifications

• Experience
• Strong knowledge of Medicare Supplement and other applicable insurance policies.
• Healthcare claim adjudication processes.
• Experience handling high-volume inbound calls with a focus on one call resolution.
• Knowledge
• Excellent communication and interpersonal skills.
• Proficiency in using customer service software, databases, and tools.
• Strong problem-solving skills and attention to detail.
• Ability to work independently and as part of a team.
• Education
• A high school diploma or equivalent.
• Skills
• Customer Service Excellence: Ability to provide exceptional customer service by understanding policyholder needs, addressing concerns promptly, and ensuring a positive customer experience.
• Communication: Strong verbal and written communication skills to convey information clearly and effectively to policyholders and providers.
• Empathy and Patience: Demonstrated ability to empathize with policyholders and providers, showing patience and understanding in all interactions.
• Problem-Solving: Aptitude for identifying issues, evaluating options, and implementing effective solutions in a timely manner.
• Attention to Detail: Keen attention to detail to ensure accuracy in handling customer information, claim(s) processing and maintaining records.
• Industry Knowledge: Up-to-date knowledge of Medicare Supplement insurance, Centers for Medicare, and Medicaid Services (CMS) guidelines and claim adjudication processes.
• Technical Proficiency: Familiar with customer service software, databases, and other relevant tools to manage customer interactions and records.
• Time Management: Ability to handle multiple tasks efficiently, prioritize work, and manage time efficiently in a high-volume environment.
• Adaptability: Flexibility to adapt to changing industry trends, company policies and policyholder needs.
• Team Collaboration: Capability to work collaboratively with colleagues and other departments to achieve common goals and ensure seamless service delivery.

Work Environment / Physical Requirements

• The work environment is a standard office setting with typical office equipment.
• This role involves professional collaboration with colleagues and clients.
• Responsibilities may involve extended periods of sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching, stooping, and lifting office items weighing up to 25 pounds.