Health Services Facilitator (Part-Time Weekends)

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.