Job Description

JOB DESCRIPTION

POSITION : Customer Service Representative

REPORTING TO : Customer Service Supervisor or Manager

DEPARTMENT : Customer Service

Career Band : Band 1

JOB PURPOSE

The job holder is responsible of effectively handling inquiries from customers, clients or providers received via phone and e-mail located domestically and internationally in "real time" contact center environment. He/She interacts appropriately and efficiently with health care professionals using excellent interpersonal and listening skills, critical thinking, and problem-solving skills.

RESPONSIBILITIES AND DUTIES

• Receives requests by mail, telephone or in person regarding insurance claims/policies while operating on multiple computer applications.
• Responds to inquiries from policy holders, providers and/or others for information and assistance.
• Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
• Mails or routes claims forms and supporting documentation to various units for final processing.
• Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
• May seek assistance with complex customer services issues.
• Understand and interprets policy provisions.
• Performs research to respond to inquiries and interprets policy provisions to determine most effective response using established departmental procedures, HIPAA regulations, and corporate policies.
• Uses computer-based resources in a highly effective manner to educate and provide accurate responses to inquiries is crucial for success.
• Issue Emergency GOP (Guarantee of Payment) and COC (Certificate of Coverage) as required when it is necessary.
• Collaborate with other stakeholders / teams to resolve queries including complex queries.
• Actively support all team members to enable operational goals to be achieved.
• Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).

KNOWLEDGE, SKILLS AND EXPERIENCE

• Strong proficiency in speaking English
• High School Diploma or equivalent required or Associates or bachelor\xe2\x80\x99s degree preferred.
• 1+ years of customer service experience analyzing and solving customer problems required, call center experience a plus.
• Intermediate proficiency in Microsoft Office Suite.
• High level capacity to multitask independently and on a computer.
• Knowledge of Medical Terminology a plus.
• Excellent written and oral communication skills.
• Ability to perform in a high volume, fast paced call center environment.
• Proven ability to work independently as well as a productive member of a team.
• Exceptional organizational and time-management focus.
• Possess excellent attention to detail, with a high level of accuracy.
• Strong interpersonal skill with good verbal and written communication, enjoy working and collaborating with team members.
• Fluent in English and Mandarin - verbal, written, reading.
• Strong customer focus with the ability to identify and solve problems.
• Should be flexible to work in shifts and on staggered weekends

COMMUNICATIONS AND WORKING RELATIONSHIPS

The job holder develops effective relationships and communications with clients to ensure a working relationship.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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