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Customer Service Representative

2 months ago

Oriskany, New York, United States Axelon Full time
Job Summary

Axelon is seeking a highly skilled Customer Service Representative to join our team. As a Customer Service Representative, you will be responsible for managing a block of assigned claims, prioritizing actions, and maintaining data integrity through accurate benefit decisions and payments.

Key Responsibilities
  • Manage overall block of assigned claims in accordance with Operational Efficiency goals, Demonstrate Service Delivery and Customer Satisfaction goals, including prioritizing actions, appropriately utilizing resources timely, maintain data integrity through accurate benefit decision and payment
  • Execute individual claim action plans, serve as point of contact for the claimant and provide a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication, and makes claim decisions. Proactively updates partners that may be working with the claimant when key events are being considered or have occurred. (Closure, RTW, etc.)
  • Accountable approves key decisions made by team member(s) within authority limit including Financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and appropriately investigates other income/offsets in accordance with Customer's plan/policy
  • Actively demonstrate key behaviors - Active and engaged participant in regularly scheduled 1:1s and daily team huddles, Promotes and participate in a work environment including successfully working with others to achieve desired results; contributes to team goals, projects; exchanges ideas, opinions, develops positive working relationships.
  • Performs other related duties as assigned or required
Essential Business Experience and Technical Skills
  • Comprehensive understanding of the disability contractual provisions, especially the definition of disability.
  • Strong communication skills, including the ability to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim.
  • Basic knowledge of medical conditions, treatments, prognosis.
  • Critical-thinking skills.
  • Ability to give and receive feedback to/from partners.
  • Strategic-thinking skills and the ability to apply judgment and decision-making based on strategy.
  • Prioritization skills. Ability to balance quantity and quality.
  • High School Diploma.
Preferred Qualifications
  • Associate Degree.
  • 2 plus years of claims management experience preferably in Healthcare field.
  • Proficient in Microsoft Word/Excel.
Key Competencies, Qualifications and Skills
  • Some college or degree preferred.
  • Prior STD and/or Family Medical Leave Act claims knowledge preferred.
  • Strong communication skills, both written and oral.
  • Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
  • Strong problem solving and analytical skills.
  • Ability to work independently.
  • Ability to multitask, comfortable working with multiple priorities in a changing environment.
  • Ability to prioritize and maintain quality.