Required BPO Executive - Bangalore

Job Summary

We are seeking a highly motivated and customer-focused BPO Executive to handle inbound calls related to insurance policies and claims. The role involves providing accurate and timely information to customers and hospitals, coordinating with internal teams for pre-authorization cases, and maintaining detailed records of all interactions. The ideal candidate should have excellent communication skills, a problem-solving mindset, and a strong understanding of health insurance processes, particularly claims and pre-authorizations. This position is crucial in ensuring customer satisfaction, minimizing escalations, and facilitating smooth coordination between customers, internal departments, and hospital networks.

Key Responsibilities

1. Inbound Call Handling

• Answer inbound customer and hospital queries related to health insurance policies, claim procedures, and pre-authorization requests.
• Handle a high volume of calls professionally and efficiently, while maintaining quality and empathy.
• Provide first-call resolution by offering accurate and complete information related to corporate and individual policy coverage.

2. Pre-Authorization Coordination

• Follow up with internal departments such as the medical review team or claims processing team for timely updates on pre-authorization (pre-auth) cases.
• Ensure pre-auth requests are logged, updated, and escalated as necessary to avoid delays in treatment at hospitals.
• Keep customers and hospital representatives informed about the status of ongoing pre-auth approvals.

3. Claims Assistance and Customer Guidance

• Assist customers in understanding claim submission procedures, required documentation, and timelines for reimbursement or cashless approvals.
• Educate customers on claim intimation, filing steps, follow-ups, and potential reasons for claim rejections or delays.
• Convince and guide policyholders about the legitimacy and rationale of specific claim outcomes in a professional and empathetic manner.

4. Status Updates and Communication

• Provide real-time updates to customers and hospitals regarding the status of claims and pre-auth cases.
• Communicate clearly through phone and email, ensuring a professional tone and resolution-focused interaction.
• Address escalations calmly and document them accurately for further investigation.

5. Tracker Management and Reporting

• Maintain daily call logs and update internal trackers with relevant case details, resolutions, and pending actions.
• Share timely updates with the escalation management team on unresolved or critical cases.
• Ensure proper documentation and categorization of all interactions in the CRM or call-handling systems.

6. Policy Information Dissemination

• Offer clear and accurate details to customers regarding corporate and retail insurance policies, including benefits, coverage limits, exclusions, and claim terms.
• Handle queries from HR or employee representatives for group/corporate policies.
• Ensure consistency in the information provided, aligning with current policy terms and underwriting guidelines.

Job Profile : BPO Executive
Industry : BPO, MBA, Diploma, bsc-bca-bbm, Walkin