Employer: Aflac
Job Summary
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 with 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.
Specialist – Education & Experience
Qualification Level Education Degree Specification
Minimum Required High School Diploma or Equivalent
Qualification Level Experience
- Minimum Required Experience in Customer Service, especially in dealing with difficult situations
- 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 and in a team setting
- Ability to handle distressed callers with patience and
- Basic Word, Excel, Outlook.
Organizational Competencies
- Acting with Integrity – Clearly states goals and beliefs; lets people know his/her true intentions; does what he/she said they would do; follows through on commitments
- Communicating Effectively – Expresses ideas and information in a clear and concise manner; tailors message to fit the interests and needs of the audience; delivers information in a manner that is interesting and compelling to the listener
- Pursuing Self-Development – Demonstrates ambition and desire to move forward in his/her career; engages others in discussions about career development; seeks feedback on ways to increase his/her performance; takes advantage of opportunities to build new skills and capabilities
- Serving Customers – Builds strong relationships with customers; stays aware of customer needs, concerns and satisfaction; responds promptly to customer questions and requests; effectively manages customer expectations
- Supporting Change – Enthusiastically participates in new change initiatives and programs; focuses on reasons why changes will work and how they will be beneficial
- Supporting Organizational Goals – Actively supports organizational goals and values; demonstrates enthusiasm toward the company’s goals and mission; aligns actions around organizational goals
- Working with Diverse Populations – Shows respect for the beliefs and traditions of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds
Working Conditions
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)
Travel
- None Required