Customer Service Representative

hace 7 días

Lima, Perú Teleperformance Peru A tiempo completo

Overview:
The expert must be able to comprehend and analyze the reason why the customer is calling and the appropriate procedure to resolve it. During the process, the agent must provide a specific resolution to each customer and assure an excellent call handling to meet customer expectations. In addition to politeness, empathy, soft skills, fluency with American English and focus on serving the caller are important requirements.

**Responsibilities**:

- Advocate for the member and/or caller by making the interaction hassle-free. Some examples would include contacting providers, pharmacies, or ancillary providers.
- Compassionately own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
- Effectively ensures members are connected to appropriate specialists and/or enrolled in the correct programs, based on member’s needs and eligibility.
- Compassionately respond and resolve member service inquiries related to:

- Medical benefits, eligibility, and claims.
- Terminology and plan design.
- Billing inquiries.
- Pharmacy benefits, eligibility, and claims.
- Correspondence requests.
- Accurately capture member grievances and file determination requests.
- Compassionately educate members about the fundamentals of health care benefits including:

- Managing health and well-being.
- Offer Next Best Actions on account and follow up appropriately
- Assist members in appointment scheduling to proactively address gaps in care.
- Provider education and choosing a quality care provider.
- Maximizing the value of their health plan benefits.
- Pre-authorization and pre-determination requests and status.
- Provide compassion and maximize use of community services, support programs, and resources available to member.
- Advocate must be experienced in member tools, benefit interpretation and accurate documentation to interpret situation and proactively address member issues. Advocate must be able to proactively engage members in new opportunities to close gaps in care

Qualifications:
**Technical Skills**
- High school graduate (Must present diploma or certificate)
- English Level: B2 or above.

**Competencies and Specific Skills**
- Communication skills
- Customer orientation (Empathy)
- Problem resolution
- Attention to detail
- Problem Resolution
- Analytic Thinking
- Flexibility

**Work Experience**:

- This job position is to work in person on site*

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