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.

ESSENTIAL FUNCTIONS:

• Provides first- level problem resolution to member, provider and broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.
• 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 services 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.
• Prioritize workflow & multitask efficiently in a fast-paced environment while using multiple skill sets with demonstrated proficiency.
• Delivers accurate information to customers in accordance with performance goals and objectives.
• Maintains customer advocate records by identifying underlying customer needs and guiding them to appropriate resources or programs updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.Participates in system testing as needed and ongoing education related to new services, industry topics, and skills.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 3 years customer service experience.

Preferred Qualifications:

• 3 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: $39,240 - $71,940

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).

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, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship