Primary point of contact for the customers for all aspects related to pre-approvals/health benefits/claim status and other queries
Roles and Responsibilities:
o Assess and Analyze clinical information and medical evidences presented by medical providers
o Respond, approve or reject medical claims based on the policy holder table of benefits in a timely manner
o Give verbal and or written justification in case of rejection to provider and or policy holders in a professional manner
o Understand and follow the escalation matrix in case of complicated medical cases and or when the claim exceeds the authorized limit
o Communicate with customers through calls / emails and assist them with their inquiries.
o Redirect calls / emails to the concerned departments.
o Identify customer’s needs, clarify information, research every issue and provide solutions and/or alternatives
o Keep records of customer’s complaints/suggestions/comments, as well as actions taken
o Managing large amounts of inbounds and outbound calls in a timely manner
o Maintain the required quality for the process (Greeting – Phone Etiquette – Transferring Calls)
o Following communication “scripts” when handling different topics
o Ensure accuracy of the information provided to customer, request support from team leader if required
o Report cases that requires further follow-up by supervisor and keep customer informed with feedback
o Escalates customer issues and complaints to CSM within 24 hrs using proper documents to address the issue.
|Job Location:||Al Kuwait, Kuwait|
|Job Role:||Medical, Healthcare, and Nursing|
|Company Industry:||Healthcare, other|
|Career Level:||Mid Career|