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高端医疗险客服

Date: Jun 12, 2019

Location: 上海, CN

Company: AIA Careers

  1. Respond accurately within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first call resolution where possible.
  2. Adjudicate claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
  3. Monitor turn around times to ensure claims are settled within required time scales, highlighting when this is not achievable.
  4. Monitor and highlight high cost claims and ensure relevant parties are aware.
  5. Provide payment guarantees as required to clients and providers.
  6. Interface effectively with internal and external customers to resolve customer issues.
  7. Work closely with Sales and Account Management team to provide and develop service for clients.
  8. Identify potential process improvements and make recommendations to appropriate management staff.
  9. Actively support all team members and provide resource to enable all operational goals to be achieved
  10. Performance metrics will increase over time with proficiency and complexity of work. Initial productivity will require accurate response or completion of 15-20 items per hour, to include a mix of calls/ claims / faxes / emails)
  11. Meet or exceed Service level agreement requirements. Minimally set at a 10 day turnaround for claims or in accordance with client specific requirements. This number will be reviewed periodically and can be increased or decreased based on business need.
  12. Quality standards for both call and claim will be developed, communicated and meeting them will be part of the production requirement.
  13. Financial accuracy of 99% for coding and payment of claims