上海招聘

工作地点：上海市

招聘公司：某国际健康保险公司
Requirements:
?Responsible for investigating and resolving complaint and appeal scenarios for the Actisure business platform, which may contain multiple issues, and the co-ordination of a response that incorporates input from multiple business units, including external vendors.
?Timely, customer-focused response to complaints and appeals.
?Review and analysis of plan documents, company policies, internal processes and regulatory requirements in order to make decisions and recommendations as to how to resolve issues.
?Develop and maintain strong collaborative relationships with many operational areas, including but not limited to Member Services, Claims, Client Services, Medical Team, Network, Compliance, Legal, Complaints Grievance & Appeals and external vendors.
?Report production from the Complaints and Appeals Tracking System (CATS), trend analysis on issues and recommended training and business solutions are expected.
?Work closely with the back end service teams & Aetna International Compliance Team to identify and analyze root causes of complaints and appeals.
?Responsible for producing management information for regulatory reports.
?Managing multiple assignments, accurately and efficiently.
?Build relationships while coordinating with multiple business units.
?Identify complaint trends and issues, and recommend business solutions. Arrange regular customer complaint resolution meeting and involve the leaders of relevant business units for root cause identification and issue resolution, as well as the action plan for service/ procedure improvement.


REQUIRED COMPETENCIES
?At least 8 years of customer service experience in the insurance industry
?At least 2 years team lead experience of customer service team
?Excellent written and verbal communication skills
?Strong organization, co-ordination and prioritization skills
?Good knowledge of health care processes
?Ability to research claim processing logic to verify accuracy of claim payment, member eligibility data, billing-payment status, prior to initiation of complaint/appeal process
?Ability to research standard plan design or certification of coverage pertinent to the member to determine accuracy, appropriateness of benefits and liability denial
?Knowledge of legislation and regulations for the markets we operately in
?Ability to influence a variety of business areas to resolve complaints and appeals within required timeframes
?Good utilization of Microsoft Office Software

SKILLS AND EXPERIENCE REQUIREMENTS
?Extensive knowledge of health claims processing.
?Proven excellent service by meeting quality and turnaround key performance metrics and meeting productivity expectations.
?Excellent letter writing skills to convey a positive, professional image with our internal and external customers is essential.
?Proven ability to produce and analyze complaint/appeal statistics and written reports relating to complaint handling, resolution and tracking.
?Excellent quality results, analytical and communication skills.
?Demonstrate the ability to build a strong internal network and effective influencing skills in order to recommend resolutions within regulatory timeframes.
?Effective analysis skills to identify the complaint/service issue and recommend an appropriate resolution.
?Knowledge of the legal and regulatory environment surrounding complaints and appeals.

  开胜咨询专注企业管理综合服务行业10余年，提供各类高端企业管理项目服务、人才发展咨询服务、企业培训服务、业务外包服务等专项服务，先后服务了上千家国企、外企与民企。
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  海外业务涉及：英国、越南、美国 ；
  服务领域有生物制药与医药流通、快速与耐用消费品、机械制造、纺织品、影视娱乐、电力、港口石油、金融行业（含第三方）、地产与物业、高端保险、冷链物流等主要行业；
  开胜咨询有限公司以“专业领先、追求卓越“为企业理念，其所经营的各业态领域中均拥有强大的专家团队，为客户提供独立领域专业咨询服务和开胜独特的集团式联动咨询服务。