Hindi- English - Ortigas City, Pilipinas - RSD Human Resources Management Consultancy

Paglalarawan

Provides quality customer service by applying SCAN Five Service Principles. Educates members, family, providers and caregivers regarding benefits and plan options.
Accurately explains benefits and plan options in person, via email or telephonically.
Provides follow-up with members by clarifying the customer's issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.

Consistently meets or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance.

Responds appropriately and promptly to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids.

Takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue.

Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.

Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention.

Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.

Follows all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Group operations, as documented I company policies and procedures.

Follows all HIPAA requirements.

Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.

Responds to routine member questions and concerns on specific medical group call queues as part of skill development