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Best Doctors Insurance · 3 days ago

Customer Service Representative

Miami FL - Miami, FL 33126

Full-time

Onsite

Mid Level

3+ years exp

Best Doctors Insurance is a company focused on delivering high-quality customer service. The Customer Service Representative will manage relationships with customers, agents, and providers, addressing inquiries and complaints related to claims, products, and benefits in a professional manner.

Financial ServicesInsuranceMedical

Responsibilities

Logs, tracks, and processes appeals and grievances

Handling and solving customer complaints regarding claims process and/or service which may be complex or long-standing and coordinating the solution with the participation of departments involved

Present appeals cases to the committee assigned and preparing communication of resolution to clients and agents

Contacts customers to gather information and communicate disposition of case

Conducts pertinent research in order to evaluate, respond to, and close appeals in accordance with all established regulatory guidelines

Entering payment information in the system and follow up on pending payments

Develops relationships with all levels of clients and achieve positive reviews about service and responsiveness

Establishes productive, professional relationships with key administrative personnel in assigned agencies and agents providing training on claims guidelines, product information and portal system when necessary to ensure that the members experience Best Doctors’ highest standards of quality and care

Communicating courteously with customers by telephone, email, letter, live chat and face to face, supporting and answering any inquiry presented, related to operations, benefits and claims process

Responding to customer inquiries professionally within the turnaround time established for the area, providing systematic follow-up and feedback to improve our service and process

Coordinate and Participate on service calls with agents in weekly bases to address issues proactively, providing guidelines about our process

Provides information and knowledge to the agents about the status of the claims and payments through weekly reports

Collaborates with sales and medical staff to resolve problems and develop service enhancements

Evaluating and Researching required information using accessible resources

Handle special projects and/or other related assignments as needed by service related issues

Identify escalating priority issues and report to supervisor when necessary

Recording details of comments, inquiries, complaints and actions and/or answers given in the appropriate system

Work closely with all internal departments to request any information required to finalize a case

Ensure that customer information is kept confidential according to HIPAA guidelines

Review checks daily to ensure payments are sent with the correct payment method chosen by members

Qualification

Customer ServiceFluency in EnglishFluency in SpanishFluency in PortugueseAnalytical skillsMicrosoft OfficeHealth Insurance knowledgeCall center experienceDetail orientedTeam PlayerProblem-solving skills