Lauris Rozentals

Health Insurance - Member Services Specialist @Sensée

GB

Pre-authorise treatments and assess eligibility for a wide range of healthcare services, ensuring compliance with policy terms and clinical guidelines.• Investigate and resolve claims by gathering evidence, liaising with internal teams, and providing clear, empathetic explanations to members.• Manage complaints end-to-end, from initial acknowledgement to resolution, following FCA and companies quality standards.• Provide technical and administrative support to members, brokers, and healthcare providers maintaining service levels and KPIs.• Maintain accurate member records in CRM systems, ensuring data integrity and confidentiality in line with GDPR.• Proactively identify opportunities to improve the member experience, contributing to a 95%+ CSAT and high first-contact resolution rates.• Collaborate with cross-functional teams to resolve complex cases, including escalations and policy exceptions.

Netcom Training

BTEC Level 3 Diploma in IT