Customer Service (TPA Insurance)
About this position
Responsibilities
• Ensure that all documents related to cases such as Guarantee of Payment, Initial Medical Reports, Investigation Letter, Statement Letter, Confidential Medical Reports, Rejection Letter, etc., are sent to providers in a timely manner following the agreed SLA with clients.
• Manage all issues escalated by staff, follow up and liaise with concerned parties internally or externally.
• Provide proper solutions to any problem related to the case handling by CSEs, case directions and escalate to Operation Excellence’s Assistant Manager or Head of Operation, that leads to potential issues or clients’ concerns.
• Ensure inbound calls SLAs are under control by managing the staff formation, staff telephone skill set level are tagged correctly and monitoring staff call productivity to avoid any abandoned calls.
• Support QA in ensuring that CSE calls handling quality meets the standard requirements and conducting regular call reviews and call coaching.
• Closely monitor and simultaneously review Operation Dashboard and Task Manager, and take necessary action when needed.
• Oversee the clients’ service delivery which includes operational delivery, working with Managed Care Team and Finance Department to secure seamless claims processing.
• Ensure that the Operation Platform performance is in accordance with the client’s contractual deliverables and KPIs and that all required reports are timely presented to clients.
Requirements
• Minimum Diploma or Bachelor's Degree in any major.
• Have experience in Customer Service in Healthcare and/or Life and Health Insurance Industry.
• Min 1-3 year experience working in Customer Service.
• Having knowledge of Insurance products will be an advantage.
• Able to work in shifting hours.