The customer service agent or technician ensures the tracking of files revision requests from the sales offices and from the customer service while communicating with adherents and suppliers, if need be, to obtain necessary additional information to treat the files.
Process the returns of specific customer service cases including requests for revision, special cases, political cases or complaints online and list the frequency and nature of errors for quality assurance purposes and for training purposes .
Analyze treatment plans that require special knowledge in dental care and submit the files to the dental consultant so that they can validate them, when required.
Provide support to compensation agents and the responsible agent in the treatment of health insurance and dental care benefits or for any other request requiring the expertise of the technician.
Communicate with members and suppliers, if necessary, in order to obtain additional information necessary for processing files and offer the necessary support to customer service (call centers in Quebec, Toronto and sales offices) .
Provide the necessary support for the treatment of specific cases to the investigation and fraud team and the necessary support to the various health professionals acting as consultants for the Directorate - Management of health insurance.
Suggest improvements to the case management process based on the information gathered in the course of his work.
Validate reports related to online complaints and supplier input "