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POSITION PURPOSE:

Serve as the direct representation of the company promoting the company's level of service by evaluating, researching and answering all inquiries which include claims, products and benefits in a professional and concise manner. The Customer Service Specialist position is responsible for the management of the relationship with customers, agents and providers; maintaining the satisfaction according to the company standards.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

• Logs, tracks, and processes appeals and grievances
• Handling and solving customer complaints regarding claims process and/or service which may be complex or long-standing and coordinating the solution with the participation of departments involved.
• Present appeals cases to the committee assigned and preparing communication of resolution to clients and agents • Contacts customers to gather information and communicate disposition of case
• Conducts pertinent research in order to evaluate, respond to, and close appeals in accordance with all established regulatory guidelines
• Entering payment information in the system and follow up on pending payments
• Develops relationships with all levels of clients and achieve positive reviews about service and responsiveness.
• Establishes productive, professional relationships with key administrative personnel in assigned agencies and agents providing training on claims guidelines, product information and portal system when necessary to ensure that the members experience Best Doctors’ highest standards of quality and care
• Communicating courteously with customers by telephone, email, letter, live chat and face to face, supporting and answering any inquiry presented, related to operations, benefits and claims process.
• Responding to customer inquiries professionally within the turnaround time established for the area, providing systematic follow-up and feedback to improve our service and process.
• Coordinate and Participate on service calls with agents in weekly bases to address issues proactively, providing guidelines about our process. • Provides information and knowledge to the agents about the status of the claims and payments through weekly reports
• Collaborates with sales and medical staff to resolve problems and develop service enhancements • Evaluating and Researching required information using accessible resources
• Handle special projects and/or other related assignments as needed by service related issues • Identify escalating priority issues and report to supervisor when necessary
• Recording details of comments, inquiries, complaints and actions and/or answers given in the appropriate system.
• Work closely with all internal departments to request any information required to finalize a case
• Ensure that customer information is kept confidential according to HIPAA guidelines.
• Review checks daily to ensure payments are sent with the correct payment method chosen by members.

DESIRED MINIMUM QUALIFICATIONS: 

• Good oral and written communication skills
• Excellent Analytical skills
• Detail oriented
• Independent and self-motivated
• Able to deliver excellent customer service, externally and internally.
• Able to work under pressure 
• Team Player
• Able to react effectively and calmly to emergencies
• Ability to Multi-task
• Computer literate with good keyboard skills.
• Complete Fluency in English, Spanish and Portuguese
• Good presentations skills, to a small or large audience
• Skills to take ownership of a problem and help to create a solution

EDUCATION AND EXPERIENCE:

• Associates Degree or higher
• 3+ years’ experience in Customer Service, dealing with very demanding clients in different countries.
• Familiar with standard concepts, practices, and procedures of Health Insurance
• Relies on experience and judgment to plan and accomplish goals

NECESSARY KNOWLEDGE: 

• Excellent computer skills with proficiency in Microsoft Word, Excel, PowerPoint and Outlook.
• Experience working within healthcare industry and claims
• Experience working within a call center environment a plus