Allshores is seeking a Part Time Health Services Facilitator. The role will coordinate health care services and process related claims according to the terms and conditions of the member’s insurance policy. As a Health Services Facilitator, you will ensure to abide by the established company protocols and objectives, provide excellent customer service while addressing communications from clients and health care providers.
Primary Responsibilities:
- Responsible for managing inbound calls, emails and faxes received and direct appropriately to the team as needed.
- Address general inbound inquiries for both Cases and Claims received via calls, emails or faxes.
- Responsible for gathering all necessary information to effectively open a new case and alert the Team Lead/Manager for timely assignment.
- Manage short-term non-medically complex cases to completion by providing benefit information, network details, and providing authorizations when required.
- Present cost-effective options for treatment by utilizing network facilities, collaborating with the Provider Relations team as applicable.
- Screen and complete non-medical requests such as benefit clarifications, extended length of stay information, updates on procedures, etc.
- Maintain all records of activity related to case management, financial expectations, and strategic plans as they relate to the case within the company database system.
- Provide excellent customer service to the insured members and offer guidance and support with each inquiry.
- Maintain comprehensive and accurate case notes along with other relevant data required to effectively process claims.
- Responsible for arranging medical appointments and processing applications for benefit increases to support the Bermuda Admin role.
- Utilize problem solving skills and negotiating techniques to resolve conflicts.
- Communicate with Team Lead/ Manager as appropriate for problem solving, direction and planning, as well as knowledge issues.
- Initiate required forms, letters and/or policies to comply with organizational guidelines and initiatives.
- Adheres to all policies and procedures as outlined by One Team Health and client specific protocols.
- Perform all work in a PIPEDA and HIPAA compliant manner.
- Ensure strict standards for claimant/client confidentiality and complies with organizational and governmental regulations/policies.
- Assist with the claims processing
- Participation in statutory holiday coverage
- Other related duties as assigned.
Skills, Experience & Attributes:
- Minimum 2 years’ experience in a customer service environment.
- Knowledge of insurance and/or claims processing.
- Proven excellent listening, verbal and written communication skills.
- Post-secondary education in a relevant field or equivalent work experience.
- Proficiency in the use of the internet.
- Familiarity and knowledge of Microsoft Suite.
- Familiarity with insurance products and/or terminology is an asset
- Familiarity with medical terminology is an asset
- Enjoys interaction with clients/strong interpersonal skills.
- Maintain a positive attitude at all times especially when handling difficult situations.
- Presents a jovial and pleasant approach towards customers even under the most stressful situation.
- Show empathy for the customer’s situation.
- High level of customer service/Client focused.
- Strong listening, verbal and written communication skills.
- Possesses excellent organizational skills and able to set own priorities.
- Proactive/Takes initiative, able to work with minimal supervision, especially during slow periods.
- Professional/High level of integrity.
- Logical and analytical thinker, excellent problem-solver and decision-maker.
- Team player/Flexible/Reliable.
- Successfully manage stress, especially during peak busy hours where many things can happen all at once.
- Be able to sit for long periods of time to ensure adequate coverage.
