Responsible for providing efficient, consistent and professional bilingual customer service to plan members and providers both via prompt phone or email correspondence. Reporting to the CRC Manager, call centre agents must also ensure that all policies and procedures are followed in order to meet ClaimSecure’s accuracy rate and standard turnaround times. The CRC agent is also responsible for file maintenance, investigating claim payments and forwarding claims for re-evaluation.
Standard:
- Calls received in the queue must be answered promptly and within the established service level thresholds
- Calls left on voice mails must be returned the same business day. If the message is left after 3pm EST, then it must be dealt with the next morning.
- Calls that require research must be followed up within 1 business day and resolved within 3 business days.
- Calls will be monitored to ensure quality of service
- Company standards must be followed and adhered to in respect to follow up and response times. The above mentioned standards may change and all stakeholders will be notified.
File Maintenance:
The CRC agent is responsible for departmental file maintenance. This includes but is not limited to the following:
- Formulary maintenance
- Exception file
- Special Authorization Groups
- Calls will be monitored to ensure quality of service
- Research difficult claims The CRC agent must participate in regular training sessions of all new products. The agent must have thorough knowledge of these applications to help answer questions from members and clients.
Training:
The CRC agent must participate in regular training sessions of all new products. The agent must have thorough knowledge of these applications to help answer questions from members and clients.
Skills:
- Grade 12 with up to one year or equivalent program, with preferred requirement of other vocational or professional certification
- One to two years’ experience in a related field (ie. Data Entry, Call Centre)
- Experience in the Health Related field would be an asset
- Excellent listening and communication skills (both written and oral) which will assist in providing quality service
- Sound knowledge of MS Office
- Good interpersonal skills and the ability to function in a team environment
- Good organizational skills and the ability to prioritize workload will assist to maintain company standards
- Ability to handle multiple tasks and meet pre-determined deadlines