Smartpo 2008-6-19 10:31
Hiring Assistance Coordinator
ASSISTANCE COORDINATOR - ACM
This position is a junior to intermediate level position responsible for providing non-medical quality and efficient customer service to clients and customers.
The Assistance Coordinator is an integral member of a multidisciplinary Case Management Team, assuming responsibility for maintaining a high level of service to the client and their customers.
AC’s work in a fast pace environment with the clinical team. The Assistance Coordinator provides customer service, casework, and other services to both travel and group health insurance customers who are seeking access to health care and services in their country of origin or traveling overseas, and during an emergency when the client is already on their trip. These inquiries encompass numerous contacts and originate from customers, doctors and hospitals, groups and agent plans. Typically, these inquiries involve a variety of issues including assisting in emergent situations, verifying benefits, managing claim inquiry status calls, and coordination of service provider access overseas
[b]Qualifications and Experience: [/b]
• Post secondary education in Health administration and or insurance
• 2 years working in a customer service call center environment, Crisis Management, Emergency Assistance or insurance sales preferred.
• Familiarity with Medical Terminology an asset
• Able to multi-task
• Detail-oriented
• Excellent written and verbal communication skills
• Skills that will complement the specific products of Active Claims Management Inc.
• Proficient in PC based technologies (able to navigate the internet, work on several applications at once, and have reasonable typing speed)
[b]Essential Skills[/b]
This position demands resourcefulness, strong interpersonal and negotiation skills coupled with ability to prioritize, and in addition has the ability to;
• Work requires the ability to handle sensitive and confidential information, communicate, and exchange information with all levels of staff and external business-related agencies and members.
• Work requires AC to be self-motivated and able to work independently to assess situations and respond appropriately, make independent decisions and the ability to accept change.
• Proactively identify solutions to customer issues or concerns. Mature individual who is able to be empathetic to customer needs and know how to deal with sensitive and stressful situations.
• Adapt to on-going change and work volumes in a fast-paced, customer focused environment
• Be a team player
• Pay close attention and retain details
• Work independently
• Acquire product and business knowledge and share that knowledge with customers
• Take initiative and be accountable for work
• Use professional communication skills: verbal and written
• Use PC efficiently, email, data entry use customer database system
[b]Accountability:[/b]
• Reports to V.P. of Assistance Operations (until there is an Assistance Team Leader)
[b]Duties and Responsibilities:[/b]
• Being able to make informed decisions as it relates to coordinating services for our Group / Travel / Visitor to Canada and Student members
• Answer incoming telephone calls emergency and non-emergency assistance calls; connect with the customer to identify purpose of call and to verify their membership and/or insurance information; from customers who have purchased travel or group health insurance.
• Listen attentively and respond promptly to customer inquiries providing accurate, reliable, and complete program information educating caller on total services available
• Attends to problems or complaints from customers on the telephone or by written correspondence
• Initiate case opening process for customer; Verifies eligibility , opens cases in the ACM on line case management system
• Scan and attach reports and forms and all documents in the on line system client file
• As required assists with setting up medical appointments, transportation, medical assistance for an injured family member (or themselves) with making appropriate arrangements for hotels, air ambulance, commercial flights,
• Maintains an acceptable monthly average score and average talk time on monitoring and audits
• Monitor e-mail messages and manage according to the guidelines
• Monitor incoming faxes on the computer and manage according to guidelines
• Monitor ACM.NET home page message center and manage according to the guidelines
• Work collaboratively with and assist Clinical Team Leader and case managers
• Escalate customer concerns/issues to Team Leader for resolution when appropriate.
• Stay up-to-date on procedural changes in order to communicate accurate and reliable information to customers.
In addition to the basic tasks performed by the AC, each program / product requires additional specific work related skills and tasks performed in addition to the general task.
[b]Travel – Student – Visitor to Canada Programs[/b]
Assistance Coordinators:
• Understand basic insurance terminology
• Understand the basics of several medical travel insurance policies.
• Understand International Health Care systems and where clients may access health care, services and assistance
• Understand managed care and case management
• Receive calls from customers who have experienced medical emergencies while traveling overseas triage calls and handle appropriately as per standards and protocols and benefit provisions
• Verify their membership and/or insurance information and create a case in ACM.NET
• Respond to inquiries about our programs
• Assisting / coordinating with our clinical team and/or local agents in the destination country to ensure customers are directed to appropriate care
• Provide information on insurance claim filing procedures.
• Document all call details and actions taken in our case management system.
• Follow up on clinical reports
• Assist with preparing activity reports as required
[b] Group Assistance Coordinator[/b]
• Understand basic insurance terminology
• Understand the basics of several group travel insurance policies.
• Understand Health Care provided in the members country of origin versus International Health Care
• Understand managed care and case management
• Understand Preferred Provider Organization and how ACM utilizes their services
• Understand International classifications for health care and billing of health claims
• Understand the features and benefits of various Group Health Plans and specifically ACM’s responsibility to administering the services required by the client
• Receive calls from client, providers, employers whose members require overseas care or who have experienced medical emergencies while studying or traveling overseas
• Triage calls and handle appropriately as per standards and protocols
• Verify their membership and/or insurance information and create a case in ACM.NET
• Scan and attach appropriate documents when a case is activated in ACM.NET
• Respond to inquiries about our client’s programs
• Provide information on insurance claim filing procedures.
• Document all call details and actions taken in our case management system.
• Follow up on clinical reports and bills as required
• Assist with preparing activity reports as required
• Enter all Case Activations and Addendums as required in the client’s system as required
• Scan and upload claims for re-pricing as required
• Scan and upload documents as required
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[b]Company Background - Active Care Management[/b]
Active Care Management (ACM) offers world wide comprehensive Case and Disability Management, Medical Assistance, Claims Processing, and Cost Containment Services to the insurance industry, third party administrators, government and their agencies.
[url]www.activeclaims.com[/url]
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If you are interested, please forward a cover letter and resume to:
Human Resources
[email]hr@cyphersystems.com[/email]
