Students and graduates of the University of Georgia have the opportunity to apply for a Customer Relations Manager position at one of the insurance companies operating in Georgia.
Main Duties and Responsibilities
- Providing services to insured individuals in accordance with the company's service standards;
- Providing telephone consultations to insured individuals;
- Providing detailed information, based on clients' requests, regarding services, insurance coverage, and the provider network;
- Organizing medical services at contracted and/or non-contracted clinics within Georgia (and abroad, where applicable, if covered under the insurance contract and requested);
- Arranging family doctor consultations and home visits;
- Coordinating and managing insurance claims;
- Creating referrals for medical services in the electronic system (software) within the scope of delegated authority defined by the relevant procedures;
- Ensuring that referrals are sent to provider clinics via email;
- Requesting authorization for referrals;
- Providing insured individuals with reasoned and justified explanations, including references to relevant sources, when referrals are rejected or not authorized following review;
- Coordinating and monitoring the process of requesting authorization, approving referrals, and delivering them to the relevant recipients;
- Receiving medical documentation related to insurance claims submitted by insured individuals via email and creating requests in the electronic system for guarantee letters or reimbursement claims, as well as sending written confirmation of document receipt to the relevant recipient;
- Communicating information about approved guarantee letters to the relevant recipients, including appropriate comments and references to the sources of the decision (contract clauses, protocols, guidelines, etc.);
- Providing written, reasoned responses in the event of complaints;
- Communicating with clinics to request missing documentation when incomplete documents are submitted for reimbursement claims, guarantee letter authorization, or referral issuance;
- Explaining insurance contract terms and exclusions to insured individuals to clarify reasons for claim rejection and, when necessary, referring cases to the Complaints Department;
- Monitoring the provision of services (in cases involving home doctor visits and/or ambulance calls) in accordance with established standards;
- Assisting insured individuals in completing applications, including complaint forms, ensuring their submission to the relevant committee, and monitoring the process;
- Preparing periodic reports on one's activities for the direct supervisor;
- Reviewing problematic cases and ensuring their timely resolution, when necessary.
Requirements
- Higher medical education;
- Previous work experience in the insurance sector in a similar position is mandatory;
- Knowledge of computer and standard office software.
For further information, please contact the Career Development and Employment Office. Professional career guidance and consultation are also available to help you successfully present yourself to potential employers.
Contact Information
E-mail: career@ug.edu.ge
Tel: +995 511 30 27 47
Address: University of Georgia, Building IV, Room 108a
