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Benefits Services Representative - Call Centre - Jobs in Waterloo, Ontario

Ontario Teachers Insurance Plan
Job LocationWaterloo, Ontario
EducationNot Mentioned
SalaryNot Mentioned
IndustryNot Mentioned
Functional AreaNot Mentioned
Job TypeFull time

Job Description

Job Description

  • Provides timely and accurate information in response to incoming telephone inquiries using an automated telephone system, computer applications, training material and other applicable resources.
  • Resolves member complaints regarding coverage, claims and service, and documents outcomes for future reference. This includes clarifying members’ complaints, investigating the problem, developing solutions, making recommendations to management, and following-up to ensure resolution.
  • Works with the carrier to process claim adjustment requests and cheque stop-payments, and reissues requests related to claims adjudication issues, while ensuring decisions are made on a timely basis. Identifies trends in claim adjudication errors and problems.
  • Responds to member email inquiries from the department’s email queue within specified department turnaround times.
  • Provides information in response to inquiries from members and other departments regarding coverage, effective dates and outstanding information, as requested.
  • Ensures a high level of customer satisfaction through effective support and excellent customer service, by providing quick and accurate service in a professional manor.
  • Drafts letters and prepares and processes responses to routine correspondence, while adhering to established standards.
  • Applies proper contractual provisions in accordance with related contracts and carrier requirements to determine member eligibility for requested benefits.
  • Issues member confirmation notices in response to member telephone inquiries and prints the necessary documents, as required.
  • Maintains historical records by filing documents and records of insurance transactions and maintaining master files, amendments, etc.
  • Maintains a comprehensive log and diary system, and reviewing and flagging all problem situations for discussion with management, as required.
  • Keeps information confidential to protect operations.

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