The Customer Care Representative is responsible for providing expertise and customer service support to members, customers, and/or providers. They will handle direct phone-based caller interaction to answer and resolve a wide variety of inquiries.
Principal Duties & Responsibilities
- Provides initial phone contact with members, prospective members, providers, agents and field personnel while meeting department performance standards. Expected to answer inquiries where appropriate and route calls as needed. Inquires will include benefit and eligibility quotes, claim status, claim issues, premium modes, premium payments and updates, address corrections which may include Select services areas, product interests, and policy cancellations.
- Data Entry – Update member account information as needed and required, enter new individual and group member applications, enter claims, encounters and utilizations, and all other data entry needs as required, but not excluding other departmental requests.
- Research member account history, plan, payment options, complaints and other discrepancies; and correct as needed when advised by a supervisor or appropriate personnel.
- Verify insurance – Fax/mail Argus Fee Schedules, Member Eligibility Information, Provider/Facility location information, and authorizations when required in accordance to policy and procedures.
- Special Projects – Assemble group packets, pull, fill, and mail Agent requested supplies (including mass mailings to providers and members when required).
- Utilizes customer service strategies such as active listening, expressing empathy, problem solving, courtesy, and other skills deemed necessary.
- Documents, tracks, and communicates issues appropriately using and accurately to deliver high quality customer service.
- Performs the necessary skills to maintain a high-quality customer experience, as reflected through quality monitors, member feedback, and peer interaction.
- Provide back-up to other units within the division as needed.
- Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
- Other related duties as assigned.
Education & Experience Required
- Minimum Required High School Diploma or Equivalent Qualification Level Experience
- Minimum Required Experience in Customer Service, especially in dealing with difficult situations
Education & Experience Preferred
- Preferred Experience in hospitals, healthcare and/or insurance industry
- Preferred Knowledge of medical coding and terminology
- Preferred Knowledge of Medicare
Or an equivalent combination of education and experience.
Job Knowledge & Skills
- Ability to multi-task Ability to multi-task
- Demonstrated interpersonal/verbal communication skills
- written communication skills Strong verbal and written communication skills
- Ability to work as part of a team
- Ability to work independently Ability to work independently and in a team setting
- Ability to handle distressed callers with patience and
- Basic Word, Excel, Outlook.
- Acting with Integrity
- Communicating Effectively
- Pursuing Self-Development
- Serving Customers
- Supporting Change
- Supporting Organizational Goals
- Working with Diverse Populations
The statements below describe the general nature and level of the work and are not an exhaustive list of all responsibilities, duties, and skills required.
Normal office environment (virtual or in-person)
JOB URL: https://careers.aflac.com/job/Customer-Care-Representative-Dental-&-Vision-FL/880248500/
To apply for this job please visit careers.aflac.com.
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