Primary Role Description
We are seeking a highly motivated and experienced individual from a medical background to join our team as a Medical Claims Call Center Representative. In this role, you will be responsible for handling inbound customer calls related to claims and the rejection of claims. Your primary focus will be to provide exceptional customer service while resolving customer inquiries and concerns effectively.
Key Roles & Responsibilities
- Answer incoming customer calls in a professional and timely manner.
- Assist customers with inquiries including medical claims and rejections.
- Provide accurate and detailed information about claim procedures, documentation requirements, and coverage.
- Investigate and resolve customer concerns, ensuring high levels of customer satisfaction.
- Collaborate with internal departments, such as claims processing to address and resolve complex issues.
- Maintain thorough and up-to-date knowledge of products, medical billing codes, and claim processes.
- Document customer interactions and update customer records accurately in the system.
- Identify and escalate critical or unresolved issues to the appropriate department or supervisor.
- Adhere to company policies, procedures, and compliance guidelines.
Key Requirements Education & Certificate
- Any Life science, Paramedical, Medical Graduates and Postgraduates (Pharmacy, Physiotherapy, Nursing, Health education) or equivalent degree
Key Requirements - Experience & Skills
- A minimum of 1-3 years of experience in a call center environment, preferably in a healthcare or medical insurance setting.
- Strong knowledge of medical terminology, insurance claim procedures, and billing codes.
- Ability to contribute to revenue basis cross sell.
- Excellent verbal and written communication skills.
- Ability to handle high call volumes and prioritize customer needs effectively.
- Strong problem-solving and decision-making abilities.
- Attention to detail and accuracy in data entry and documentation.
- Exceptional customer service skills with a friendly and professional demeanor.
- Proficiency in using computer systems, including customer relationship management (CRM) software and Microsoft Office Suite.
- Ability to work effectively in a team-oriented environment.
- Flexibility to work shifts as per business requirements.
Key Functional Competencies 
