Claims Processing System
DESCRIBE YOUR CUSTOMER SERVICE PROCESS WHEN AN EMPLOYEE CALLS WITH A CLAIM INQUIRY.
The Customer Service Representative (CSR) will take the following steps:
Gather member data (such as ID number, etc.) and outline the concern
Research the issue and respond to the caller
Take additional steps to resolve the issue, such as placing calls to provider offices
Reprocess the claim when appropriate
Provide explanation of benefits
Log the call for future reference
WHAT IS THE AVERAGE SPEED OF ANSWER FOR CUSTOMER SERVICE CALLS?
All calls are answered within industry standards, 91.6% answered in 60 seconds.
WHAT IS THE AVERAGE NUMBER OF WEEKLY CALLS TAKEN BY THE CUSTOMER SERVICE DEPARTMENT?
The current weekly average number of calls received by the Advantek customer service department is 1900.
HOW ARE CUSTOMER SERVICE CALLS MONITORED AND REVIEWED FOR ACCURACY?
The Advantek Customer Service manager randomly monitors calls on a daily basis. All notes, route sheets, claim request forms and research material are reviewed by the Manager to ensure accuracy and appropriate communication.
WHO WILL BE ASSIGNED TO HANDLE CUSTOMER SERVICE INQUIRIES?
Specific Advantek customer service representatives will be responsible for prospective clients.