Customer Service Advisor
Customer Service Advisor
Do you have excellent customer service skills and a passion for helping people? Are you looking for a rewarding career in the private medical industry where your work can have a direct impact on people's lives? If so, you might be the perfect fit for our Member Advisor role!
As a Member Advisor you will be responsible for coordinating member treatment plans, liaising with all members of the healthcare team and the member, and ensuring that the member receives appropriate medical information and access to required medical services. This is a role where good customer service skills are key, and you are not required to have any medical qualifications.
PERSON SPECIFICATION
We are looking for an individual who can deliver great customer service and who has strong command of the English language, both verbal and written.
In addition, we are looking for:
Decision making skills and ability to use own initiative.
A diplomatic open style and approach, with excellent verbal and written communication.
A high degree of accuracy and attention to detail and work well under pressure.
The ability to work well both independently and as part of a team.
Good problem solving and analytical skills.
Good commercial awareness with the ability to make decisions with the "bigger picture" in mind.
Ability to make effective contact with clinicians, accurate assessment of information obtained and acting appropriately upon the outcome.
An overall external awareness of new technology or development within the industry to pre-empt and be prepared for possible related queries.
A good understanding and previous experience of the private medical insurance industry and claims processing, would be an advantage.
About this role
AS MEMBER ADVISOR, YOU WILL BE INVOLVED IN:
Taking calls from clients, providers and specified members in relation to initial and/or ongoing claims
Obtaining medical evidence from providers to substantiate claims decision/treatment
Dealing with queries in relation to clinical treatment or pre-authorisation requests
Arranging care with the appropriate medical team/facility
Ensuring treatment delivered is relevant and appropriate by monitoring ongoing treatment plans for members
Negotiating provider fees within the Healix Reasonable and Customary fees, as part of cost containment for clients
Ensuring all documents are correctly and accurately allocated on Case Management System
Assisting the Case Managers with high cost claims where required
What you will need
Required criteria
- Do you have Customer Service Experience?
- Do you have a good command of the English language?
Desired criteria
- Do you have medical claims handling experience?
