Job Summary
This job provides customer service in a LTC Insurance call center environment by primarily receiving and responding to telephone inquiries from policyholders, beneficiaries, providers, agents, or others for information concerning Long Term insurance policies by performing handling inbound and outbound calls responsibilities include initiating a Long Term Care claims as well as follow-up for claim completion including the following duties. This job would also require advance knowledge of all processes and would be consider the subject matter expert within the department.
Supervisory Responsibilities:
This job has no supervisory responsibilities.
Duties/Responsibilities:
- Responsible for initial interaction with Insured/Provider/Family, etc. to gather information by following a script with open ended and reflexive questioning
- Responsible for timely follow ups involving outbound calls to claim intake contact person in order to complete intake script if minimum necessary questions have not been answered
- Ability to recognize a misdirected call and the knowledge to know where to appropriately direct the caller so that their inquiries can be best addressed
- Provides information and assistance to providers, agents, policyholders, and others by responding to telephone inquiries from the client, LTC Insurance policy holders , and their representative regarding policy
- Accurately provide information regarding various LTC insurance policy related questions (i.e., any change required in policy with respect to address change, bank change, name change etc.) by accessing and updating software system data within company response standards.
- Provides service and follow-up on LTC insurance questions by researching company records to obtain information requested by customer
- Ability to successfully handle all level of calls including Admin, Claim, and Specialty calls
- Maintains working knowledge base of all company products and services.
- Complying with company regulations regarding HIPAA, confidentiality, and private health information.
- Providing written and oral communication to policyholders and their representatives regarding a LTC insurance policy that is in question
- Initiate and complete Call Tracks, Intake Scripts, checklists, and supportive clerical responsibilities as necessary for completing LTC claims call
- Ability and Flexibility to work various shifts as required.
- Ability to speak with Empathy and Concern to Policyholders
- Provide training to news and existing CCC Representatives on specific job tasks procedures and SOP’s , including specific client company guidelines
- Communicate with CCC Supervisors, Leads, Managers, and/or Director of Business operations of any “red flags” regarding workload, training deficiencies or tools needed for job performance.
- Provide input and data as required to support SLA requirements
- Handles escalated complaints in a timely manner
- Provides feedback to Manager regarding service failures or client concerns
Required Skills/Abilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- High school diploma or general education degree (GED); and six months related experience and/or training; or equivalent combination of education and experience.
- Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
- Customer Service, excellent communication skills, Integrity/Honesty, Oral Communication, Motivation, Organizational/Planning/Organizing,
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
- Typing speed of 45 WPM with a 90% accuracy rate.
- Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
- Proficiency in computer applications (including Word, Excel and Outlook) is required
- Familiar with Medical Terminology definitions and coding
- Proficiency in computer applications (including Word, Excel and Outlook) is required
Education and Experience:
High school diploma or general education degree (GED); and six months related experience and/or training; or equivalent combination of education and experience.
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision.