Health Services Facilitator (Part-Time Weekends)

Job summary

Coordinate health care services and process claims, including managing inquiries, opening and completing cases, providing benefit and network information, and arranging authorizations and appointments. Maintain accurate case records, support claims processing, protect confidential information, and provide empathetic customer service while following company, client, PIPEDA, and HIPAA requirements.

Job details

Allshores is seeking a Part Time Health Services Facilitator. The role will coordinate health care services and process related claims according to the terms and conditions of the member’s insurance policy. As a Health Services Facilitator, you will ensure to abide by the established company protocols and objectives, provide excellent customer service while addressing communications from clients and health care providers. Primary Responsibilities: Responsible for managing inbound calls, emails and faxes received and direct appropriately to the team as needed. Address general inbound inquiries for both Cases and Claims received via calls, emails or faxes. Responsible for gathering all necessary information to effectively open a new case and alert the Team Lead/Manager for timely assignment. Manage short-term non-medically complex cases to completion by providing benefit information, network details, and providing authorizations when required. Present cost-effective options for treatment by utilizing network facilities, collaborating with the Provider Relations team as applicable. Screen and complete non-medical requests such as benefit clarifications, extended length of stay information, updates on procedures, etc. Maintain all records of activity related to case management, financial expectations, and strategic plans as they relate to the case within the company database system. Provide excellent customer service to the insured members and offer guidance and support with each inquiry. Maintain comprehensive and accurate case notes along with other relevant data required to effectively process claims. Responsible for arranging medical appointments and processing applications for benefit increases to support the Bermuda Admin role. Utilize problem solving skills and negotiating techniques to resolve conflicts. Communicate with Team Lead/ Manager as appropriate for problem solving, direction and planning, as well as knowledge issues. Initiate required forms, letters and/or policies to comply with organizational guidelines and initiatives. Adheres to all policies and procedures as outlined by One Team Health and client specific protocols. Perform all work in a PIPEDA and HIPAA compliant manner. Ensure strict standards for claimant/client confidentiality and complies with organizational and governmental regulations/policies. Assist with the claims processing Participation in statutory holiday coverage Other related duties as assigned. Skills, Experience & Attributes: Minimum 2 years’ experience in a customer service environment. Knowledge of insurance and/or claims processing. Proven excellent listening, verbal and written communication skills. Post-secondary education in a relevant field or equivalent work experience. Proficiency in the use of the internet. Familiarity and knowledge of Microsoft Suite. Familiarity with insurance products and/or terminology is an asset Familiarity with medical terminology is an asset Enjoys interaction with clients/strong interpersonal skills. Maintain a positive attitude at all times especially when handling difficult situations. Presents a jovial and pleasant approach towards customers even under the most stressful situation. Show empathy for the customer’s situation. High level of customer service/Client focused. Strong listening, verbal and written communication skills. Possesses excellent organizational skills and able to set own priorities. Proactive/Takes initiative, able to work with minimal supervision, especially during slow periods. Professional/High level of integrity. Logical and analytical thinker, excellent problem-solver and decision-maker. Team player/Flexible/Reliable. Successfully manage stress, especially during peak busy hours where many things can happen all at once. Be able to sit for long periods of time to ensure adequate coverage.

What you’ll do

Coordinate health care services and process claims, including managing inquiries, opening and completing cases, providing benefit and network information, and arranging authorizations and appointments. Maintain accurate case records, support claims processing, protect confidential information, and provide empathetic customer service while following company, client, PIPEDA, and HIPAA requirements.

Requirements

Requires at least two years of customer service experience, knowledge of insurance or claims processing, and post-secondary education in a relevant field or equivalent work experience. Candidates should have strong communication, listening, organizational, problem-solving, and interpersonal skills, along with proficiency using the internet and familiarity with Microsoft Suite.

Listed skills

• Customer service · Preferred
• written communication · Preferred
• Problem solving · Preferred
• Organization · Preferred
• interpersonal skills · Preferred
• case management · Preferred
• Negotiation · Preferred
• Prioritization · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Customer Service
• Insurance Claims Processing
• Case Management
• Inbound Call Management
• Written Communication
• Verbal Communication
• Active Listening
• Medical Terminology
• Microsoft Suite
• Problem-Solving
• Negotiation
• Organization
• Prioritization
• Analytical Thinking
• Confidentiality Compliance
• Interpersonal Skills

Job areas

• Healthcare
• Customer Service & Support
• Finance & Accounting
• Administrative