Customer Service-Life Claims

Job Overview:

The
Contact Center Representative
, is the first point of contact for customers seeking assistance filing a claim and insurance inquiries. Primary responsibilities will include providing empathic exceptional customer service by answering calls, assist with initiation of a death claim, assist with policy information, verifying eligibility, claims, and ensuring the satisfaction of each client.

Key Responsibilities:

Customer Service:

• Answer inbound /make outbound calls and speak with the customers filing a death claim by accessing the customer's profile in the client system and verifying eligibility
• Access customer account information via client's computer software, making/notating all necessary entries to resolve problems and/or complaints; initiate, schedule or change a service request, process transactions, setup accurately transportation services, etc.
• Communicate with customer in an empathetic, pleasant and professional way; effectively and clearly resolving any issues reported. It will require excellent oral communication skills (grammar, enunciation, pronunciation).
• Educate customers about their insurance policies, including coverage limits, exclusions, and procedures for filing claims.
• Cope with, and diffuse stressful situations; manage and control of calls with tact and diplomacy.
• Help customers understand their policy details, including coverage, exclusions, and benefits.
• Answer inquiries related to policy coverage, benefits, deductibles, and claims processes.
• Provide exceptional customer service by ensuring timely resolution of customer inquiries and concerns.
• Follow up with customers on pending claims or benefit inquiries and provide updates as needed.
• Provide customers with cutting-edge service in a friendly, confident, and knowledgeable manner

Claims Assistance:

• Assist customers in filing claims, explaining the claims process, and providing status updates.
• Assist customers in the claims process by gathering necessary information, explaining next steps, and coordinating with other departments as required.
• Follow up on claims status and provide updates to customers.

Problem Resolution:

• Conduct issue identification and problem-solving meeting customer needs and satisfaction
• Investigate and resolve any issues or concerns related to claims or benefits, escalating complex cases to supervisors when necessary.
• Use independent judgment, logic and analytical skills in problem solving.
• Resolve issues related to billing, policy discrepancies, claims processing, and other customer concerns.
• Escalate complex issues to senior staff or appropriate departments when necessary.

Documentation & Data Entry:

• Process and document claims, benefits requests, and customer interactions accurately within the system.
• Utilize various internal and client-based tools and applications for customer management and service
• Accurately document customer interactions and actions taken in the company's CRM system.
• Ensure customer records are updated promptly and thoroughly.

Policy Knowledge & Compliance:

• Maintain a high level of knowledge regarding the company's products, services, and claims processes to provide accurate information to customers.
• Maintain a deep understanding of insurance policies, terms, and regulations to provide informed assistance.
• Adhere to company protocols and industry regulations, including privacy laws and confidentiality agreements.

Performance & Quality Assurance:

• Meet or exceed service targets, including call resolution times, customer satisfaction scores, and other key performance indicators (KPIs).
• Participate in training and professional development programs to improve skills and knowledge.
• Meet or exceed performance metrics such as call resolution times, customer satisfaction scores, and adherence to schedules.
• Achieve and maintain required metrics and goals.
• Work and partner with others within a team-based environment

Qualifications & Skills:

• Education:
  High School diploma or equivalent required. Associate's or Bachelor's degree is a plus.
• 1+ year previous experience in a life insurance customer service contact center role; life insurance produce domain knowledge is
  required
• Knowledge of insurance products and terminology
• Empathic to the caller's situation
• Strong verbal and written communication skills.
• Excellent listening and problem-solving abilities.
• Ability to work in a fast-paced environment while maintaining accuracy.
• Proficiency with computer systems and CRM software.
• Detail-oriented with strong organizational skills.
• Ability to handle sensitive customer information with discretion