Claims Customer Service Representative

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    "requisitionDescription": "<div><p data-pasted=\"true\"><strong><u>Job Summary:</u></strong></p><p>The Customer Service Representative (&ldquo;CSR&rdquo;) role is responsible for providing support and assistance to&nbsp;</p><p>Bankers Fidelity&rsquo;s policyholders and providers by handling high-volume inbound calls, addressing&nbsp;</p><p>inquiries, resolving issues efficiently and providing detailed information about benefits, claims, and&nbsp;</p><p>policy provisions. Emphasis will be placed on achieving a one call resolution to ensure the highest level&nbsp;</p><p>of customer satisfaction. In this role, the CSR will be an ambassador of Bankers Fidelity&rsquo;s mission to</p><p>deliver exceptional insurance solutions with accuracy, integrity, empathy, and professionalism. The CSR&nbsp;</p><p>will uphold Bankers Fidelity&rsquo;s core values of customer-centricity, accountability, and continuous&nbsp;</p><p>improvement by providing reliable and compassionate service to Bankers Fidelity&rsquo;s policyholders and&nbsp;</p><p>other internal/external stakeholders. The CSR will demonstrate the ability to communicate effectively&nbsp;</p><p>and resolve issues promptly to reinforce the trust and confidence policyholders place in Bankers Fidelity,&nbsp;</p><p>ensuring their experience aligns with the ongoing promise of quality service and support.</p><p><strong><u>Key Responsibilities:</u></strong></p><p>&bull; Customer Service:</p><p>o Handle high volume inbound customer inquiries via phone, ensuring prompt and professional&nbsp;</p><p>service.</p><p>o Provide accurate and comprehensive information about insurance policies, benefits, and&nbsp;</p><p>coverage.</p><p>o Resolve customer complaints and issues within a single call whenever possible, aiming for one&nbsp;</p><p>call resolution.</p><p>&bull; Claim Adjudication:</p><p>o Demonstrate a thorough understanding of healthcare and other applicable insurance claim&nbsp;</p><p>adjudication processes to accurately address and resolve policyholder inquiries and issues.</p><p>o Assist providers with claim(s) processing, including guidance for claim submission, clarifying&nbsp;</p><p>reimbursement procedures, and ensuring compliance with Medicare and industry guidelines.</p><p>o Educate customers about the claim adjudication process and policy details.</p><p>Disclaimer: This job description is not all-inclusive, and additional duties may be assigned. Bankers Fidelity provides reasonable accommodations for individuals&nbsp;</p><p>with disabilities as required by law. As an Equal Opportunity Employer, we consider all qualified applicants without regard to race, color, religion, sex, sexual&nbsp;</p><p>orientation, gender identity, national origin, disability, or veteran status. Employment is at-will and may be terminated at any time, with or without cause or&nbsp;</p><p>notice.</p><p>&bull; Daily Operations:</p><p>o Maintain accurate and up-to-date records of customer interactions and transactions.</p><p>o Collaborate with other departments, including Medicare Supplement Claims Examiners,&nbsp;</p><p>Ancillary Examiners, and other stakeholders to ensure seamless service delivery.</p><p>o Identify and escalate complex issues to the appropriate department for further resolution.</p><p>o Demonstrate Bankers Fidelity&rsquo;s commitment to integrity, empathy, and professionalism in every&nbsp;</p><p>customer interaction.</p><p>&bull; Training and Development:</p><p>o Stay informed about industry trends, CMS guidelines, and company policies related to Medicare&nbsp;</p><p>Supplement and all other applicable insurance.</p><p><strong><u>Qualifications:</u></strong></p><p>&bull; Experience:</p><p>o Strong knowledge of Medicare Supplement and other applicable insurance policies</p><p>o Healthcare claim adjudication processes&nbsp;</p><p>o Experience handling high-volume inbound calls with a focus on one call resolution.</p><p>&bull; Knowledge:</p><p>o Excellent communication and interpersonal skills.</p><p>o Proficiency in using customer service software, databases, and tools.</p><p>o Strong problem-solving skills and attention to detail.</p><p>o Ability to work independently and as part of a team.</p><p>&bull; Education:&nbsp;</p><p>o High school diploma or equivalent</p><p><strong><u>Skills:</u></strong></p><p>&bull; Customer Service Excellence: Ability to provide exceptional customer service by understanding&nbsp;</p><p>policyholder needs, addressing concerns promptly, and ensuring a positive customer&nbsp;</p><p>experience.</p><p>&bull; Communication: Strong verbal and written communication skills to convey information clearly&nbsp;</p><p>and effectively to policyholders and providers.</p><p>&bull; Empathy and Patience: Demonstrated ability to empathize with policyholders and providers,&nbsp;</p><p>showing patience and understanding in all interactions.</p><p>&bull; Problem-Solving: Aptitude for identifying issues, evaluating options, and implementing effective&nbsp;</p><p>solutions in a timely manner.</p><p>&bull; Attention to Detail: Keen attention to detail to ensure accuracy in handling customer&nbsp;</p><p>information, claim(s) processing and maintaining records.</p><p>&bull; Industry Knowledge: Up-to-date knowledge of Medicare Supplement insurance, Centers for&nbsp;</p><p>Medicare, and Medicaid Services (CMS) guidelines and claim adjudication processes.</p><p>&bull; Technical Proficiency: Familiar with customer service software, databases, and other relevant&nbsp;</p><p>tools to manage customer interactions and records.</p><p>&bull; Time Management: Ability to handle multiple tasks efficiently, prioritize work, and manage time&nbsp;</p><p>efficiently in a high-volume environment.</p><p>Disclaimer: This job description is not all-inclusive, and additional duties may be assigned. Bankers Fidelity provides reasonable accommodations for individuals&nbsp;</p><p>with disabilities as required by law. As an Equal Opportunity Employer, we consider all qualified applicants without regard to race, color, religion, sex, sexual&nbsp;</p><p>orientation, gender identity, national origin, disability, or veteran status. Employment is at-will and may be terminated at any time, with or without cause or&nbsp;</p><p>notice.</p><p>&bull; Adaptability: Flexibility to adapt to changing industry trends, company policies and policyholder&nbsp;</p><p>needs.</p><p>&bull; Team Collaboration: Capability to work collaboratively with colleagues and other departments&nbsp;</p><p>to achieve common goals and ensure seamless service delivery.</p><p><strong><u>Work Environment / Physical Requirements:</u></strong></p><p>The work environment is a standard office setting with typical office equipment. This role involves&nbsp;</p><p>professional collaboration with colleagues and clients. Responsibilities may involve extended periods of&nbsp;</p><p>sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching,&nbsp;</p><p>stooping, and lifting office items weighing up to 25 pounds</p></div>\n",
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