Customer Support Services - Health Insurance
Processor RoleJob Responsibilities and Expectations
- Handle inbound and outbound customer service calls related to policy inquiries, claims status, and benefit clarifications.
- Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines
- Ability to communicate effectively across multiple channels, including phone, e-mail, chat, and text
- Ability to succinctly collect information from a customer to set up a new claim
- Ability to gather information from multiple source systems to understand and articulate the status of a claim and what information may be needed, next steps in processing, etc.
- Respond to customer emails and chat queries in a timely and professional manner.
- Provide accurate information on health insurance products, policy terms, and coverage details.
- Assist customers with policy servicing requests such as address changes, ID card reissuance, and premium payment queries.
- Log all customer interactions in the CRM system with appropriate categorization and follow-up actions.
- Escalate unresolved or complex issues to the appropriate internal teams while ensuring customer satisfaction.
- Maintain up-to-date knowledge of company products, services, and regulatory changes in Hong Kongs health insurance market.
- Ensure compliance with the Personal Data (Privacy) Ordinance (PDPO) and Insurance Authority (IA) guidelines during all interactions.
- Support customer onboarding and orientation for new policyholders.
- Participate in training sessions and quality audits to improve service delivery.
Academic and Additional Qualifications Needed
- Associate Degree in Business Administration, Insurance, or related field.
- 13 years of experience in customer service, preferably in the healthcare insurance sector.
- Proficiency in CRM systems and Microsoft Office applications.
- Strong communication, empathy, and problem-solving skills.
Quality Review Role
Job Responsibilities and Expectations
- Monitor and evaluate customer service interactions to ensure adherence to quality standards and regulatory compliance.
- Conduct call audits and review written correspondence for accuracy, tone, and completeness.
- Identify service gaps and provide constructive feedback to processors for performance improvement.
- Develop and maintain quality scorecards and reporting dashboards.
- Collaborate with training teams to address recurring service issues and knowledge gaps.
- Ensure compliance with Hong Kongs Insurance Authority (IA) regulations and internal service protocols.
- Support internal audits and regulatory inspections by providing documentation and quality metrics.
- Assist in updating standard operating procedures (SOPs) based on audit findings and regulatory updates.
- Participate in calibration sessions to align quality expectations across teams.
- Mentor junior staff on best practices in customer service delivery.
Academic and Additional Qualifications Needed
- Bachelors degree in Insurance, Business, or Healthcare Administration.
- 47 years of experience in customer service or quality assurance in the health insurance industry.
- Familiarity with IA regulations, PDPO, and customer service KPIs.
- Analytical mindset with attention to detail and strong documentation skills.
Supervisor Role
Job Responsibilities and Expectations
- Supervise a team of customer service representatives and ensure daily service level targets are met.
- Manage workforce scheduling, attendance, and performance tracking.
- Resolve escalated customer issues and coordinate with internal departments for resolution.
- Conduct regular team meetings, coaching sessions, and performance reviews.
- Analyze service metrics and implement process improvements to enhance customer satisfaction.
- Ensure team compliance with Hong Kongs Insurance Authority (IA) regulations and internal policies.
- Support implementation of new systems, tools, and service workflows.
- Collaborate with training and quality teams to upskill staff and maintain service excellence.
- Prepare reports for management on team performance, customer feedback, and service trends.
- Foster a customer-centric culture and promote continuous improvement.
Academic and Additional Qualifications Needed
- Bachelors degree in Business, Insurance, or Healthcare Management.
- 810 years of experience in customer service with at least 2 years in a supervisory role in the insurance sector.
- Strong leadership, conflict resolution, and team management skills.
- Knowledge of CRM systems, IA regulations, and service quality frameworks.
Manager Role
Job Responsibilities and Expectations
- Lead the strategic planning and execution of customer support services for the health insurance division.
- Define service delivery goals, KPIs, and customer experience benchmarks.
- Oversee budgeting, staffing, and resource allocation for the customer service department.
- Ensure compliance with all regulatory requirements from the Insurance Authority (IA) and PDPO.
- Drive digital transformation initiatives to enhance customer engagement and operational efficiency.
- Represent the customer service function in cross-functional leadership meetings and regulatory reviews.
- Develop and implement customer retention and satisfaction strategies.
- Monitor industry trends and regulatory changes to adapt service models accordingly.
- Manage vendor relationships for outsourced service functions, if applicable.
- Mentor and develop leadership talent within the customer service team.
Academic and Additional Qualifications Needed
- Bachelors or Masters degree in Business Administration, Insurance, or Healthcare Management.
- 10+ years of experience in customer service with at least 3 years in a managerial role in the health insurance domain.
- Proven track record in strategic planning, regulatory compliance, and customer experience management.
- Strong leadership, stakeholder management, and change management capabilities.
Valid PAN Number - _____________________(Why PAN Required > Mandatory to Process Candidature & Find Duplicity in Internal PAN Validation Process and also to initiate a screening call.
Please reach out in case of any queries.
Sonali Chattopadhyay I Associate People Success
Orcapod Consulting Services Pvt Ltd.
Email I sonali.chattopadhyay@orcapod.work
www.orcapodservices.com 9548431649
