Resp & Qualifications

PURPOSE:

Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications.

Maintains a more advanced knowledge of company products and services. Mentor and lead lower-level Customer Service Advocates.

ESSENTIAL FUNCTIONS:

• Uses knowledge of products or services by collecting and the contractual provisions that govern administration to provide customer information service and analyzing education to interpret contractual language to the customer needs for the purpose of providing benefit utilization and limitations to determine the need for managed care initiatives and to administer all types of service to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments if applicable. Appropriately documents all client interactions according to established departmental procedures.
• Resolves highly complex member, provider and broker inquires by gathering and investigating information; verifying customer understanding of information and resolves issues based on applicable policies and procedures; examine claim submissions verifying claim and system accuracy as well as liability. Prioritize workflow and multitask efficiently in a fast-paced environment while using multiple skill sets with demonstrated high proficiency.
• Acts as the lead Customer Service Advocates to ensure that the team provides accurate and consistent information to inquiries in a courteous, timely, and professional manner. Mentors and coaches' team on policies changes, system updates, learning tools, or other job requirements to provide a consistent base for new employees.
• Maintains a positive and enthusiastic attitude in an environment that requires teamwork, efficiency, cross-training, and continuous improvement.
• Ensures compliance with Standard Operating Procedures and serves as a resource to the staff.

SUPERVISORY RESPONSIBILITY: Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 5 years customer service experience.

Preferred Qualifications:

• 5 or more years experience in a call center customer service role or experience with medical or insurance terminology.

Knowledge, Skills and Abilities (KSAs)

• Demonstrated skills as an empathetic and compassionate communicator.
• Ability to quickly gain customer trust and confidence.
• Demonstrated PC navigation and data entry skills.
• Strong interpersonal communication skills.
• Good oral and written communication skills. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $43,920 - $80,520 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Medicare/Medicaid Member Service

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race