CareFirst Careers

Account Liaison, TPA

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Resp & Qualifications

PRINCIPAL ACCOUNTABILITIES:

1. Provide day-to-day, quality client services support to accounts, brokers, members, wholesalers, administrators and service vendors.  Develop and maintain external and internal working relationships to facilitate the resolution of clients’ benefit administration concerns, service and systems issues.  Acknowledge, troubleshoot/research, resolve and respond to all incoming problems and complaints; offer alternative solutions to enhance existing plan guidelines when needed.   Educate clients on benefits, eligibility and self-service products, and assist with interpretation of contractual benefits/clauses.

2. As part of the account management service team attend new group implementation meetings and provide support and feedback to the account managers to insure all installation efforts are progressing satisfactorily. Meet regularly with the account management service team to discuss existing accounts to resolve issues that may develop to inhibit successful retention or renewal.  Attend group conference calls, open enrollment benefit/health fairs and employee meetings.

3. Complete assigned special projects as directed; i.e., fast loads, deductibles, coinsurance, out of pocket and lifetime maximums, enrollment notes updates, systems issues impacting claims that need to reprocessed or adjusted, etc. Assist in the development, documentation and implementation of standard operating procedures (SOPs) and other quality management projects.

4. Update, document and maintain internal databases and systems as required (i.e., TPA On-line, LuminX, LIN, telephone inquiry system, etc.). Request reports via the Report Database as needed.

5. Provide back-up support to the Call Center and the account management service team as needed.

QUALIFICATION REQUIREMENTS:

Abilities/Skills:    This position requires a strong service oriented attitude, and excellent written and oral communication skills.  Organizational, analytical, problem solving, decision making, leadership, time management, and project management skills are essential.  This job also requires the ability to build positive relationships, both internally and externally, to be able to work with people to accomplish tasks successfully. Strong PC skills in using software such as Word, Excel, Power Point and other office software are essential. Incumbent requires an A.B.S. degree or equivalent and 3-5 years of industry related experience. A working knowledge of BCBS of Maryland contracts, GHMSI contracts, National Account matrix contracts, service agreements, and HMO contracts is desired. In addition, general knowledge of the various CareFirst systems is preferred, along with a working knowledge of NCAS and CFA systems (i.e., Health Axis, LuminX, CEW – LIN, telephone/call tracking, vendor databases, etc.).

Preferred:  Strong background in claims adjudication and/or processing

Department

Department: Account Management

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.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 7/12/2018

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

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