Call Center Representative

• Process clients’ first notice of loss claim reports received through Zurich’s phone & non-phone reporting options in a timely and accurate manner
• Resolve complex claims inquiries and problems, judging when to pass complex queries on to or involve others to provide an effective service and clear advice to colleagues and customers
• Liaise with internal and external clients to exchange information, clarify facts, and resolve queries and/or problems efficiently
• Provide feedback and recommendations to the team to improve the quality of customer care
• Follow procedures to ensure adherence to the company’s risk and compliance policies

Claims Call Center Representative

• Make an average of 50 outbound calls per hour placed by an automatic dialer system to offer, explain, and schedule a free in-home or virtual health evaluation with a provider
• Follow 20+ approved scripts, ensure members understand and are comfortable with the terms, and respond to rebuttals persuasively and with professional courtesy
• Present a positive, professional, and high energy approach to clients, health plan members, and team members
• Meet daily goals set by the department (i.e., 300-400 outbound dials per day, 25 appointments set per day, shift and attendance policy adherence, quality targets, etc.) in an office or remote environment
• Adjust, reschedule, and cancel appointments with both members and contracted providers, as requested
• Monitor performance results including appointments, calls, handle time, and productivity using designated reporting systems
• Report member complaints and escalations immediately to Member Engagement Managers
• Participate in peer side-by-side coaching as needed
• Follow HIPAA and other security and privacy guidelines when handling protected health information accessed during normal work activities

Outbound Call Center Rep

• Monitor Physician EHR inboxes and patient portal requests and perform tasks within LPN scope of practice, and respond to patient inquiries according to established protocols.
• Refill prescription requests by established protocols, notify providers and ensure patient care tasks are completed for critical results, and coordinate follow-up care post-discharge or post-operative.
• Facilitate referrals and collaborate on addressing prior authorization requests that require clinical consultation, while also assisting with requests from other agencies such as hospitals, Public Health departments, nursing homes, funeral homes, and Departments of Labor or Motor.
• Manage Remote Patient Monitoring (RPM) results by tracking patients' real-time disease results and delivering education on managing chronic diseases such as diabetes, hypertension, and COPD.
• Medically screen and qualify patients for clinical trials.
• Perform follow-ups and patient education.
• Carry out additional responsibilities as needed to assist the healthcare team and enhance the delivery of patient education.

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Claims Call Center Representative

Outbound Call Center Rep

Licensed Practical Nurse, Compact License Required – Part-Time, Call Center