Hybrid role - Requires going to the Miami office
Job Purpose :
The position exists to oversee Corporate Client requests, respond in a timely manner, and act as a liaison between the client and operational teams or coordinate services to meet client needs.
Responsibilities :
- Client Care Management (50%)
- Handle client requests effectively, coordinate activities with operational teams, providers, and suppliers.
- Maintain accurate documentation of claims, benefits, member information, and client communications.
- Review and assess activities for each claim, including communication with providers and managing billing and reimbursement requests.
- Escalate provider issues and coordinate medical appointments.
- Provide insurance information, contact providers for bill finalization, and perform account reviews and reconciliations.
- Develop relationships with internal teams and share feedback.
- Respond to bill queries and payment status inquiries, ensuring high customer service levels.
- Tools and Resources (45%)
- Validate incoming communications and documents, ensuring integrity and meeting service targets.
- Create and validate claims and policies within the system.
- Interpret system information and respond accurately to clients and providers.
- Resolve minor escalations, assist with data entry, and support internal queries.
- Work closely with Claims Team to understand the claims process and support funding and collection activities.
- Continuous Learning (5%)
- Familiarize with international healthcare markets and internal responsibilities.
- Engage in learning opportunities related to systems, processes, and industry awareness.
Success Measures :
Achieve quality, accuracy, and performance targets in Client Care Management.Meet internal and external service level targets.Maintain high standards in quality audits and compliance regulations.Participate in and apply learnings from training activities.Major Accountabilities :
Oversee claim activities and ensure customer experience standards.Provide timely updates internally and externally.Deliver quality service and escalate complex issues appropriately.Major Challenges :
Managing cases across multiple markets with distinct requirements.Navigating international provider requirements.Understanding internal processes and making autonomous decisions in a fast-paced environment.KSA (Knowledge, Skills, Abilities) :
Knowledge of healthcare services and billing practices.Proficiency with Microsoft Office and adaptable to new tools.Customer service principles and application.Ability to work independently, organize, prioritize, and multitask.Resourcefulness, decision-making, and interpersonal skills.Excellent communication skills in English and Spanish.Requirements and Qualifications :
High school or post-secondary education or equivalent.Minimum two years in customer service and industry experience.Fluent in English and Spanish, both verbal and written.J-18808-Ljbffr