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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong customer service skills with the ability to respond to inquiries, document interactions, and maintain accurate records. Proficient in utilizing data analytics and cloud-based tools while adhering to data governance and security standards.
Highest-signal resume keywords
Customer Service ExperienceCall Centre OperationsData Analytics ProficiencyMedical BackgroundMS Office Fluency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Customer ServiceCall HandlingProblem AnalysisClaims AdjudicationDatabase Management
Soft Skills
Effective CommunicationInterpersonal SkillsAttention to Detail
Tools & Technologies
MS OfficeCloud-Based ToolsArtificial IntelligenceMachine Learning
Certifications & Qualifications
Bachelor's Degree
Industry Keywords
TPA HospitalsMedical CentersCustomer InquiriesGuarantee of PaymentData Governance
Tech Stack
Tools & technologiesCloud
About the role
Key responsibilities & impact- Respond to telephone inquiries about company products or services using standard scripts and procedures.
- Ensure calls are answered within predetermined time scales and handled to high customer-service standards.
- Answer inbound calls and assist customers and providers with specific inquiries.
- Make outbound follow-up calls for cases, additional medical reports, second medical opinions, and complaints.
- Build customer interest in company services and products.
- Provide personalized customer service.
- Update databases with changes and customer/member status.
- Document telephone conversations and actions taken.
- Correspond with the Care Centre Team Leader and Assistant Manager.
- Maintain records, close-loop calls, complete clerical duties, and liaise with other departments.
- Analyze problems and develop logical solutions within the permitted scope of work.
- Adjudicate pre-approval claims exceeding standard turnaround time.
- Issue Guarantee of Payment (GOP) documents as required.
- Follow Nextcare policies, schemes, and agreed client communication/update time frames.
Requirements
What you’ll need- Bachelors Degree; Medical background preferred.
- 2+ years experience in a Call Centre/ Customer Service environment; TPA Hospitals or Medical Centers exposure a plus.
- Physically fit to carry out duties.
- Legally permitted to work in the country of operations.
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
- Ability to work effectively with artificial intelligence, machine learning, data analytics, and cloud-based tools while following data governance, security, and ethical-use standards.
Benefits
Comp & perks- Equal opportunity employer
- Inclusive culture encouraging employees to speak their minds, get involved, and question the status quo
- AI-powered tools that streamline claims processes and reduce administrative burdens
- Human oversight for claims to maintain service integrity
- Ethical AI practices safeguarding data integrity and trust
