Job Purpose
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.
A BCSR Bilingual Customer Service Representative is responsible of Direct communications with Members, Providers, Corporate Clients via phone, email and any type of communication. Register Policies in the system with proper eligibility, add Members/dependents and create appropriate tasks that will trigger proper workflow. Documentation of all calls or communications in the Members record (when applicable) Confirmation of Benefits and Eligibility information to members and providers. Identify medical services that require an authorization from the Corporate Client and take appropriate actions. Ensure that Providers send claims to the proper address for processing and/or payment and that only the correct amounts are collected from the patient (deductible, co-payments, etc.). Provide referrals to in network Providers to all Members, Corporate Clients and sometime other Providers, confirmation of participation of a specific Provider in the network. Provide claims information like status, process date, detailed payment amount, check number, discounts taken, etc. to Members, Corporate Clients and Providers by making the necessary contacts. Assist on resolving any billing issue by contacting the appropriate department and/or parties involved.
Requirements:
✓ Bilingual (English & Spanish).
✓ Must be detail-oriented and organized.
✓ Must possess critical thinking skills as well as the ability to manage time efficiently.
✓ 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.
Tipo de puesto: Tiempo completo, Por tiempo indeterminado
Beneficios:
- Programa de referidos
- Prestaciones de Ley
- Seguro de gastos médicos mayores
- Seguro de vida
- Vacaciones de Ley
- Vales de Despensa
- Prima Vacacional 100%
- Aguinaldo 30 Días
Idioma:
Lugar de trabajo: Empleo presencial
Job Types: Full-time, Contract, Permanent
Pay: $16,535.00 per month
Work Location: In person
