Claims Customer Service Representative

The Claims Customer Service Representative role is to assist the Claims Handlers in performing its day-to-day health claims activities.

Essential Duties and Responsibilities:

Customer Service:

• Assist in Investigating, negotiating and finalising health claims.

• Handle calls and emails and respond to simple and complex enquiries regarding policy coverage or claims and provide information as requested. 

• Attend queries from insured, and medical service providers claims related issues, eligibility, covered benefits, approval status and payment issues.

• Assist in handling inpatient claims as per Company internal policies and procedures.

• Provide timely service, which ensures prompt and fair settlement of claims in accordance with company policies and guidelines. 

• Handle any complaint associated with a claim in collaboration with concerned department. 

• Ensure that clients receive exceptional customer experience.

Administration:

• Assist in the analysis of insurance policies and contracts to establish the receivability of the claim.

• Provide support in evaluating each claim assigned and conducting investigations where necessary.

• Monitor progress on claims and keep the client / your reporting line informed accordingly. 

• Input claims related data on the claims information system utilising knowledge of medical terminology.

• Document all relevant claims processing activities through Company systems and procedures.

• Scanning of claims & associated documents.

• Prepare dispatch of medical claim to concern insurers along with Claims list.

• Contact clients for missing information ,documents etc..

• Provide reports as and when required required.

• Keep up to date with insurance product knowledge.

Qualifications & Experience:

• An HSC with Biology as main subject would be an advantage.

• General medical knowledge would be an advantage.

• At least 3-5 years’ experience in a customer-oriented/ service sector.

Specialised Knowledge and skills:

• Empathy

• Ready to be trained in scale of costs and health claims

• Ability to take decisions and initiatives

• Possess good listening and problem solving skills

• Excellent verbal & written communication skills

• Good negotiation skills

• Excellent interpersonal skills

• Customer obsession

• Build and maintain strong, long-lasting customer relationships

• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude

• Possess flexibility and adaptability to manage changing work requirements and varying volumes of work

• Ability to work co-operatively and effectively within the team and the company

• Ability to work independently and to carry out assignments to completion within set parameters

• Ability to manage multiple tasks simultaneously, solve problems, and meets deadlines

• Being proactive, accountable and taking ownership of tasks assigned / duties to handle

• Good computer proficiency (MS Office – Word, Excel and Outlook).