Customer Service
Bupa - Miami, FL

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Job Purpose:
Deliver personalized service and support to producers, providers and policy holders; assumes a proactive approach to delivering exceptional support and service by contacting producers to resolve issues before they escalate. Identifies and resolves member claims and policy questions, concerns or complaints with a sense of urgency in order to ensure customer satisfaction.

Accountabilities & Activities:
Handles calls and emails from Business Partner’s, Top Agents, Members and Service Centers within department expectations to meet company service objectives

Resolves questions and issues concerning delays in new business applications, requests for appeals, all of which must be followed through to resolution. Provides management and professional guidance to team members through regular one-on-one meetings, regular team meetings, monthly account reviews, and performance goals.

Handles inquiries concerning reimbursement, policy payments via credit card, request for proof of renewal payments, and proof of coverage; complies within service guidelines and objectives.

Delivers personalized customer care to agents 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 due for renewal as a high priority, to guarantee that the policy is renewed.

Runs reports by agent and analyzes activity, follows up on applications, determines reason for processing delays and follows up to ensure resolution.

Troubleshoots questions concerning commissions, for agents ensuring that the reply is delivered within preset service standards.

Proactively places calls to top agents to ensure satisfaction and anticipates future needs or problems.

Able to identify an incorrectly processed claim (i.e. incorrect case handling, payments and diagnosis) and able to cross reference claims among systems.

Receives agents visiting the office and schedules training if possible.

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

Qualifications, Training & Experience:
College degree 2 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 read and write with excellent communication skills in both languages.

Sound knowledge of MS Office software

Core Competencies:
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.

Judgement Skills:
This position resolves agent and member problems with a heightened sense of urgency by utilizing product knowledge, system competency, and an ability to work effectively with other service areas. Requests and obtains necessary information to overcome the obstacles to effectively solve issues within the given deadline to exceed established levels of customer satisfaction. High level of emotional intelligence for effective handling of account management practices.

Freedom of Action:
Manages daily tasks under own initiative with minimal supervision, identifying customer complaints or requests and obtaining needed assistance to resolve issues when required.

Determines when and if necessary to involve medical team Doctor to explain reasons for claim denial or in-depth explanation of benefits to ensure customer needs are met in accordance with service guidelines and department call resolution objectives.

Works under own initiative within the confines of deadlines and department objectives to manage and organize work volume to meet customer demands.

Self motivated and able to work effectively with other Customer Service personnel to identify areas of delay that could impede resolving issues within set deadlines and acceptable service guidelines.

This position shares accountability for meeting company objectives by adhering to key performance guidelines, share/obtain information to resolve issues within turnaround time and deliver personalized customer service to international customer base for assigned region.

The work is performed with a keen sense of urgency in a customer driven, fast paced, dynamic office environment. May require international travel.

Works with a diversified international client base, which requires knowledge of current socio-political events and the customs of assigned countries to effectively communicate and offer viable resolution.

About this company
232 reviews
With almost 300 Bupa care homes across the UK, plus an ongoing programme to build more and upgrade existing homes, we ensure the very best...