Customer Care Representative Sr. - Claims

Job Responsibilities and Requirements

KEY RESPONSIBILITIES

*other duties as assigned*

The Customer Care Representative Sr. is responsible for all aspects of customer experience and plays a vital role in ensuring that claims examiners can focus on their core responsibilities by handling communication, documentation, and routine inquiries efficiently. The ideal candidate will display a high level of compassion on a daily basis showing empathy, sympathy, and developed coping skills to maintain professionalism in every situation over the phone.

Duties and Responsibilities:

• Providing Claimant Details: Provides detailed information to claimants regarding short-term disability, insured or self-insured claims, and statutory claims, as well as their concurrent leave claims.
• Managing Inbound Calls: Handles inbound calls from clients and claimants, addressing inquiries and resolving issues related to claims and leave processes.
• Performing Outbound Tasks: Performs outbound voice work and tasks related to selected clients and claimants, ensuring timely communication and follow-up.
• Accurate Documentation: Accurately files and documents client and claimant information into the applicable system, ensuring that claims examiners have up-to-date and precise detail/data to work with.
• Answering Claims Questions: Answers routine claims questions and provide information specific to the intake process and reporting time, helping to streamline the workflow for claim management.
• Technical Issue Resolution: Resolves routine administrative technical issues for applicable source systems, which supports the smooth operation of claims processing.
• Maintaining Confidentiality: By adhering to HIPAA rules and maintaining a high level of confidentiality, ensures that sensitive claimant information is protected, which is crucial in claims.
• Supporting Integrated Claims: Provides direct support to claimants, assists with various tasks and ensuring that claimants receive the necessary information and assistance for 1st call resolutions.

Work Environment

• RelianceMatrix’s Customer Care Center operates 24 hours per day/7-days per week. We offer a variety of 
  schedules due to this scope of coverage.
• A Customer Care Representative Sr. must be available to work a scheduled shift between the core business hours; Mon-Fri 4am to 8pm Arizona time, and open to working some Holidays. 
• Customer Care Representative Sr. must be willing and able to work sitting in one place taking calls and speaking for the entirety of their scheduled shift (excluding scheduled breaks and lunches).
• Customer Care Representative Sr. must be willing and able to work in a fast-paced, team-oriented, dynamic inbound/outbound call center.
• Customer Care Representative Sr. must have predictable and reliable attendance and adherence to their daily and weekly assigned schedule.

REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE

*or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*

Education, Qualifications and Experience:

• GED or High School Diploma
• 2 - 3 years of call center experience or equivalent customer service experience required

• Exceptional interpersonal communication skills and the ability to work with a diverse workforce.
• Experience using web-based programs
• High Speed home internet installed for Remote/Teleworker*

Key Competencies:

• Customer Service Skills: Polite, friendly, and helpful demeanor to provide exceptional service.
• Communication Skills: Effective verbal and written communication to interact with claimants and team members.
• Empathy and Compassion: Ability to show empathy and compassion, understanding the claimant's situation and providing support.
• Attention to Detail: Strong attention to detail to accurately document information and manage claims.
• Technical Proficiency: Basic technical knowledge of computer functions and proficiency in MS Office (Word, Excel, Outlook) and web-based programs.
• Multitasking: Ability to handle multiple tasks simultaneously, such as typing and talking, while maintaining accuracy.
• Problem-Solving: Strong decision-making skills and sound judgment to resolve issues and answer inquiries.
• Confidentiality: Ability to handle confidential information with discretion and adhere to HIPAA rules.
• Patience and Understanding: Proven patience and understanding to manage stressful situations and difficult claimants.
• Organizational Skills: Ability to stay organized and manage time effectively in a fast-paced environment.
• Adaptability: Flexibility to adapt to different working environments and schedules, including holidays and various shifts.
• Interpersonal Skills: Exceptional interpersonal communication skills to work with a diverse workforce and collaborate with team members.
• Self-Motivation: Ability to work independently, stay focused, and maintain discipline in a remote work setting.
• Active Listening: Strong active listening skills to understand claimant needs and provide appropriate responses. These skills contribute to providing high-quality customer service, managing claims efficiently, and supporting the overall goals of the Customer Care team.

Ability to Travel: None

                                          

PHYSICAL REQUIREMENTS

When used in the description below, the following terms are defined as:

“Occasional”: done only from time to time, but necessary when it is performed

“Frequent”: regularly performed; generally, an act that is required on a daily basis

“Continuous”: typically performed for the majority of an employee’s shift

Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objects and otherwise using primarily the fingers rather than the entire hand.  Employees are required to have sufficient visual acuity to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employees are required to have sufficient hearing to understand verbal instruction and answer telephones.  Reliance Matrix will provide qualified employees with reasonable accommodation in accordance with applicable law.

CORE VALUES

• Collaboration
• Compassion
• Empowerment
• Integrity
• Fun

The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent in this job.

 

The expected hiring range for this position is $19.25 - $25.98 hourly. This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future.

Work location may be flexible if approved by the Company.

What We Offer

At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you.

That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.  

Our Benefits:

• An annual performance bonus for all team members
• Generous 401(k) company match that is immediately vested
• A choice of three medical plans (that include prescription drug coverage) to suit your unique needs.  For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
• Multiple options for dental and vision coverage
• Company provided Life & Disability Insurance to ensure financial protection when you need it most
• Family friendly benefits including Paid Parental Leave & Adoption Assistance 
• Hybrid work arrangements for eligible roles
• Tuition Reimbursement and Continuing Professional Education
• Paid Time Off – new hires start with at least 20 days of PTO per year in addition to nine company paid holidays.  As you grow with us, your PTO may increase based on your level within the company and years of service. 
• Volunteer days, community partnerships, and Employee Assistance Program
• Ability to connect with colleagues around the country through our Employee Resource Group program

Our Values:

• Integrity
• Empowerment
• Compassion
• Collaboration
• Fun

EEO Statement

Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.

 

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