Resp & Qualifications
The Sr. Customer Service Advisor will be part of the Customer Service Departments. The role of the incumbent is to assist our member and/ or providers in a fully competent manner. The incumbent will be assisting with 2 types of service inquiries (telephone inquiries, correspondence, email, chat). This position handles different types of cases that may be more involved cases than a Customer Service Advisor. This level may need support from senior levels of the job family.
Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer 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.
Examines adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, provider, medical policy, contracts and policy procedures. Researches, investigates and initiates resolution of pends by the processing system. Calculates and verifies deductibles, maximums, co-payments and coinsurance for resolving inquiries, facilitating adjustments, initiating extra contractual and reporting of any systems processing errors, overpayments and underpayments. Develops and applies the ability to analyze customer contracts and needs involving current product mix, risk assessment, and revenue impact. Develops service techniques and technical competence for the purpose of maximizing customer retention, satisfaction, and potential financial savings.
Effectively utilizes NASCO and/ or LuminX and/or FACETS and/or FEP Direct systems, products, contract and medical policy knowledge and processing techniques to resolve client inquiries. Demonstrates the flexibility to process and service various types of products within each line of business according to the established quality, productivity and performance metrics. Learns and retains the ability to access information and effectively administer services using the company’s automated systems.
Learns information required to effectively provide service to clients as it relates to inquires concerning pre-existing condition, knowledge of policies and riders, identification of other insurance ad coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions. Appropriately documents all client interactions according to established departmental procedures.
Prior Customer support role or call center experience
HS Diploma or equivalent
Generally 1-2yrs. Experience
Customer Focus, Customer Service, Data Entry/PC Literacy, Active Listening Skills, Articulate Communication Skills, Building Relationships, People Skills, Interpersonal Savvy, Problem Solving, Ability to Multi Task; Positive Attitude, Empathetic
Proficient with products, systems and business decision making, analytical skills, detailed oriented and problem solving skills.
Strong Work Ethic, Service Oriented Attitude, Ownership Attitude, Adaptability, Confident, Speak with Authority, Self-Motivated, Strong Time Management Skills, Stress Tolerance, Resilience
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 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.
All Service personnel may be required to dedicate up to 100% on of their productive time on phone coverage as deemed necessary by the department.
Bilingual (Spanish/English) fluency.
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
Please apply before: 12/18/2020
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.
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