Aetna Claims Enquiry Representative in Hong Kong, Hong Kong

Req ID: 38168BR

To liaise with claims team as the first point of referral for enquiries, as well as emails and telephone calls.Provide excellent customer experience to our customers liaising both internally with inhouse claims team/claims vendor/MST and externally with plan sponsor/broker/HR.Reports to Operations Manager on outstanding workloads on a daily basis via e-mail or in agreed report format.To take ownership and responsibility of customer enquiries politely and efficiently on the telephone (inbound & outbound) and over email, within boundaries of knowledge, ensuring that the claims process is as smooth as possible and enquiries are actioned within 1 working day.Participate in regular team meetings with staff and record minutes/action points when required.Assist/deal with projects as directed by Operations Manager.Keep the Operations Manager informed of procedural barriers and suggested enhancements.To resolve any technical or contentious queries within the boundaries of medical knowledge and policy held.To ensure that all computer records are up-to date and accurate.To ensure data protection questions have been satisfied before information is provided to any caller.To identify all complaints upon receipt and deal with any as the first point of contact within technical skill level.Ensure all complaints are accurately logged on internal systems.To help analyse complaints trends and assist with the implemention of subsequent remedial actions.To liaise with any internal or external contacts to discuss medical conditions. To continually strive to improve and develop medical knowledge. To log and report on all claims enquiries received and answered, providing analysis on any trends that may occur.Produce scheduled and ad-hoc claims reports when agreed by underwriting for other offices.Develop and maintain working relationships with business partners, providers, brokers and agents, to the highest level of customer service possible.To promote the best image for the company through professional appearance and behaviours.Adhere to company standards and procedures. To maintain the highest level of personal conduct.

Job Function: Claim