Customer Service Representative
Evaluates preauthorization requests from providers and customers. Deliver personalized service and provide support to brokers, providers and policy holders. . Identifies and resolves member claims and customer questions, concerns or complaints with a sense of urgency in order to ensure customer satisfaction.
- Manage claim requests, notification and preauthorization questions via phone and email from members and providers within given deadlines and service objectives.
- Sends letter of authorization or denial and explanation of benefits depending on the treatment evaluation.
- Enters notes for every conversation, email and decision in the system so that it is available Companywide.
- Handles calls and emails from Business Partner’s, Brokers, Members and Service Centers within department expectations to meet company service objectives
- Resolves questions and issues concerning delays in new business applications, requests.
- Delivers personalized customer care to brokers and Policy holders by resolving issues personally, regardless of the question or issue, calls back with information or resolution within set deadlines, exceeding customer expectations.
- Handles questions or claims issues for policies.
- Able to identify an incorrectly processed claim (i.e. incorrect case handling, payments and diagnosis) and able to cross reference claims among systems.
- May receives visits from Policy holders visiting Miami.
- Supports the call center staff in order to meet customer service Key Performance Indicators.
- Documents all communication in the system to ensure access for everyone.
- Handles request for proof of insurance.
- Performs other related tasks as assigned.
The Ideal Candidate
- College degree 4 years or equivalent in healthcare or business administration with relevant experience preferred.
- 2-3 years insurance or health care and/or claims experience preferred
- 1-2 years call center experience preferred.
- Significant customer service experience 3-4 years required
- Experience in handling high-end “niche” customers to ensure high level degree of customer service satisfaction.
- Bilingual English and Spanish fluently read and write with excellent verbal communication skills in both languages. Required.
- Experience with Medical terminology billing and coding preferred
- Sound knowledge of MS Office software
- Strong customer service skills and rapport building skills.
- Exceptional interpersonal and rapport-building skills.
- Excellent problem solving skills utilizing patience diplomacy and empathy in support of an international and multicultural client base.
- Self motivated, with ability to work independently while working effectively in a team.
- Excellent organizational, time management, prioritizing and multitasking skills
- Demonstrate initiative, flexibility and ability to drive and embrace change.
- Ability to make decisions that benefit the business while also serving the customer.
- Must be comfortable working in fast paced and changing environment; ideal candidate will have an entrepreneurial spirit that enjoys working in a start-up business environment.
About the Company
Bupa’s purpose is longer, healthier, happier lives.
As a leading global health and care company, we offer health insurance, medical subscription and other health and care funding products; we run care homes, retirement and care villages, primary care, diagnostic and wellness centres, hospitals and dental clinics. We also provide workplace health services, home healthcare, health assessments and long-term condition management services. We have 32M customers in 190 countries. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ 84,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, Thailand, and the USA.
We have grown significantly, particularly through 2013 to 2015, when we accelerated execution of our Bupa 2020 strategic vision. We are similar in revenue and profit to Marks & Spencer, and larger than Heinz in revenue. Because Bupa does not have shareholders it does not have a listing, but if it did it would be in the FTSE 100. Bupa is not a mutual or a charity but a company limited by guarantee that seeks to maximise its profits in order to fulfil its purpose. With customers in virtually every country in the world and 70% of its revenues now generated outside the UK, Bupa is a truly international organisation.
Bupa believes that the growth and performance of our leaders and our people is the single biggest pathway to fulfilling our purpose (longer, healthier, happier lives) and delivering Bupa’s 2020 goals. We have a leadership framework called “Bupa Leaders Are” which sets out what great leadership looks like at Bupa. Leaders are called upon to grow themselves, to grow others, to grow the business, and fulfil our purpose: longer, healthier, happier, lives. We are looking for individuals who are capable of delivering extraordinary business outcomes.
Bupa’s International Markets (IM) unit has 16 million customers in 190 countries across all continents around the world. It manages a portfolio of businesses, including a large international health insurance, travel insurance and medical assistance business called Bupa Global, as well as established domestic health insurance businesses in Hong Kong and Thailand, two associate health insurance companies in Saudi Arabia (26.25% Bupa ownership) and India (49% Bupa ownership), and Hong Kong’s largest private clinic network.
Bupa Global provides products and services worldwide to people who want access to premium health and care at home or as they study, live, travel or work abroad. We provide international health insurance, travel insurance and medical assistance to individuals, small businesses and global corporate customers all around the world.
Bupa Global has over 1,800 employees and has offices in London and Brighton (UK), Miami (USA), Copenhagen (Denmark), Hong Kong (Greater China), and Dubai (UAE), as well as in Egypt, Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador. Bupa Global is currently organised around five regional hubs: Bupa Global Middle East, Africa and India; Bupa Global Greater China; Bupa Global Latin America; Bupa Global North America and Bupa Global Europe.
Timescales for reviewing applications will differ between regions, but you will always receive a response to your application. The recruitment process itself will vary per role and region, but you will be updated along the way via phone and email (so please look out for these!). To view what stage of the process your application is currently at, you can also log in and view your dashboard.
If you are invited to an interview, a member of the resourcing team will be able to advise you on what to expect. This will vary in region, but will likely include an initial phone or digital interview, followed by one or more of the following depending on the role: Core capability interview; Technical/function specific interview; Online profiling assessment; Presentation, written task, role play; Assessment centre.
If your application is successful and you’re invited to join the team, the resourcing team will guide you through your on boarding journey.
Should you require any reasonable adjustments to be made or facilities provided to enable you to attend an interview, please do not hesitate to contact us prior to the interview at firstname.lastname@example.org, so we can make adjustments accordingly.