1. Customer Service
• Ensures the provision of quality service to all clients by building a relationship with clients based on reliability/dependability of service and concern for members.
• Provides quality service by extending assistance 24/7 to members to respond to their needs during time of access and clarifying/and or answering queries regarding their benefits coverage.
• Serves as conduit for the communication of needs, concerns, and requirements between client and departments of the company.
• Attends to VIP cases, disapproved cases, borderline cases in order to optimize goodwill, without sacrificing the interest of of the company.
2. Renewal of Accounts
• Reviews existing accounts health care plan and determines their utilization by coordinating with Actuarial, Medical, Claims and Underwriting Departments in order to design a renewal contract of health care with value-adding benefits and services and best-price offer. Interacts with Actuarial Department in order to rationalize rates to make them competitive; recommends another pricing approach for certain special cases.
• Prepares ABC for renewal accounts
• Conducts presentations with clients on renewal proposals and for new accounts in the existing account.
• Upsells AMF (Annual Membership Fees):
• Negotiates with client’s health care plan coverage and pricing, following guidelines, policies and standards of the company.
• Negotiates with clients, together with Broker or Agent, health care plan coverage and pricing, following guidelines, policies and standards of company
3. Utilization Review
• Regularly checks account’s utilization to spot financial risks and recommend intervention when indicated.
4. Orientation Programs
• Ensures that clients and members understand their benefits package and access procedures by organizing orientation sessions
5. Annual Physical Examination (APE)
• Ensures that APE is conducted as scheduled for all clients with the help of Medical Department and/or Call center thru Client Service Assistant.
6. Account Monitoring
• Uses multiple monitoring mechanisms to know status of accounts and special situations occurring, and where needed, take action to the satisfaction of the client/member: Account Profile, collections/ payments, documentation of special cases, etc.
• Ensures that all communications with clients are available and kept for future reference.
