Korean Customer Service Representative (CSR) to support our Korean- speaking health insurance clients. As a CSR, you will handle more complex inquiries and escalations related to health insurance policies, claims, and disputes. You will act as
a resource for resolving intricate issues that require in-depth knowledge of insurance processes and policy details. Fluency in both Korean and English is essential, along with strong problem-solving skills and a customer-focused mindset.
Advanced Customer Support:
o Handle escalated and complex inquiries from Korean-speaking customers via phone, email, and chat.
o Assist with detailed questions related to health insurance plans, including policy terms, exclusions, coverage limits, and claims processes.
o Provide personalized support to resolve customer issues related to claim denials, policy disputes, and billing discrepancies.
o Act as a point of contact for customers needing advanced assistance beyond support.
Claims Resolution and Policy Management:
o Investigate and resolve escalated claims issues by coordinating with the claims, underwriting, and billing departments.
o Offer detailed explanations of denied claims, guiding customers through the appeals process if necessary.
o Support customers in understanding and utilizing their policy benefits, deductibles, co-pays, and out-of-pocket expenses.
Escalation Handling and Case Management:
o Manage customer escalations professionally and efficiently, ensuring timely and accurate resolutions.
o Document all escalated cases in the CRM system, including detailed notes on the issue, resolution steps, and outcomes.
o Follow up with customers to ensure satisfaction and confirm that their issues have been fully resolved.
Collaboration and Feedback:
o Collaborate with internal teams (claims, billing, and product teams) to address more complex customer needs and policy adjustments.
o Provide feedback on recurring customer issues and offer suggestions for process improvements.
o Mentor CSRs by sharing knowledge, best practices, and assisting with challenging cases.
Compliance and Confidentiality:
o Ensure that all communications and processes comply with industry regulations, such as HIPAA, and protect the confidentiality of customer information.
o Adhere to company policies and legal requirements regarding health insurance products and services.
Continuous Improvement:
o Stay up-to-date with changes in health insurance policies, products, and regulatory guidelines.
o Participate in ongoing training and development programs to enhance customer service skills and knowledge of insurance offerings.
Requirements
Language Proficiency: Native or fluent in Korean (speaking, reading, and writing) and proficient in English.
Experience: 2-3 years of experience in a customer service role, preferably in health insurance or the healthcare industry.
Health Insurance Knowledge: In-depth understanding of health insurance policies, claims processes, and billing procedures is required.
Problem-Solving Skills: Strong analytical skills to diagnose and resolve complex customer issues.
Technical Skills: Experience with CRM systems, call center software, and case management tools.
Key Competencies
Customer Focus: Demonstrates empathy and provides thoughtful solutions for complex customer issues.
Attention to Detail: Ensures accuracy in documentation, claims processing, and reporting.
Critical Thinking: Ability to analyze problems and recommend effective solutions quickly.
Collaboration: Works well with internal teams to resolve escalations and improve customer service processes.
Benefits
- HMO with 1 free dependent upon hire
- Life Insurance
- Work onsite
- Night Shift (10% Night Differential)
- 20 PTO credits upon regularization
- Great Company Culture
- Career Growth and Learnings
