SUPPORT EMPLOYEES BY BEING A RESOURCE FOR TECHNICAL QUESTIONS (30%)

• Answer questions received from the Claims Assessors
• Obtain all the necessary information from the Claims Assessors and respond accurately to their questions.
• Provide information/instructions in a clear concise manner.

HANDLE LEVEL 1 ESCALATIONS (10%)

• Take ownership of complaints or complex files, as well as escalated calls and/or emails to ensure the claim is resolved or escalated accordingly.
• Communicate professionally with internal teams.

ADMINISTRATIVE SUPPORT (10%)

• Ensure reference documents, workflows and guidelines are up to date.
• Respond to Customer emails according to the business needs.
• Review calls to obtain missing info.
• Complete other administrative tasks as delegated by the Team Leader and as per business needs.

Major Challenges

• Staying current on systems, processes and products
• Working with groups and individuals with different personalities, expectations, and performance levels
• Managing diverse tasks and changing priorities
• Being attentive to small claim details and exercising attention to detail
• Remaining calm and professional in difficult situations

Major Job Accountabilities

• Accuracy – providing accurate information to Assessors and Customers as per policy wording, Client expectations and/or financial history.
• Quality – providing professional service as per the quality guidelines and both external and internal communication holds a high level of professionalism and customer service.
• Efficiency – completing work within the targeted timeframes while managing multiple priorities i.e. Task turnaround times, client expectations, training and project deadlines, etc.

Success Measures

• Claims are processed accurately and efficiently including management of escalations.
• Inquiries are responded to in an appropriate timeframe, both internally and externally
• Reference material, training material and guidelines and tools are kept current and reviewed at regular frequencies.
• Areas of improvement for team and individuals are identified and performance concerns are communicated with leadership in a timely manner.

KSA (Knowledge, Skills and Abilities/Attitudes)

• Knowledge of claims adjudication and related processes
• Superior customer service skills
• Excellent verbal and written communication skills
• Excellent interpersonal skills
• Strong decision-making and organizational skills
• Autonomous, professional, and detail-oriented
• Ability to multitask and prioritize.
• Proficiency in the Microsoft suite products