Claims Customer Service Representative

Customer Service Representative

The Customer Service Representative ("CSR") role is responsible for providing support and assistance to Bankers Fidelity's policyholders and providers by handling high-volume inbound calls, addressing inquiries, resolving issues efficiently and providing detailed information about benefits, claims, and policy provisions. Emphasis will be placed on achieving a one call resolution to ensure the highest level of customer satisfaction. In this role, the CSR will be an ambassador of Bankers Fidelity's mission to deliver exceptional insurance solutions with accuracy, integrity, empathy, and professionalism. The CSR will uphold Bankers Fidelity's core values of customer-centricity, accountability, and continuous improvement by providing reliable and compassionate service to Bankers Fidelity's policyholders and other internal/external stakeholders. The CSR will demonstrate the ability to communicate effectively and resolve issues promptly to reinforce the trust and confidence policyholders place in Bankers Fidelity, ensuring their experience aligns with the ongoing promise of quality service and support.

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.
• 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:
• 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.