Resp & Qualifications
The scope of this position is focused on more strategic and long term approaches to improving the overall performance and the development of both the associate staff and department.
The Sr. Customer Service Advocate will be part of the Customer Service Departments. The role of the incumbent is to assist our member and provider with the more complex support required. The incumbent will be assisting with all types of SBU relatedservice inquiries (telephone, correspondence, email, chat). This position handles more involved cases than a Customer Service Advocate.
The incumbent must have the ability to handle a more specialized communication specific to the SBU; such as social media, written communication, email, lobby, etc. They should perform in another area of service expertise to include claims processing of adjustments, claims adjudication; complex claims adjustments, processing of emails and written correspondence. Additionally, the incumbent must be a product specific subject matter expert and should demonstrate proficiency in training, coaching and function as a subject matter expert and as a motivational resource for the levels below this job. Independent inventory management skills necessary.
Provides effective support in coaching, training and the motivation of Level I, II and III associates. Assists and supports the department and team with maintaining cases, adjustments and correspondence inventories using proven best practices. Development of clinics and workshops to assist associate staff with meeting the inventory metrics.
Functions as a subject matter expert with increased visibility at meetings, conference calls and projects as a representative stakeholder in the outcome of corporate, departmental and divisional initiatives. Serves as a liaison with other departments within the company to negotiate the resolution of customer inquiries. Investigates, analyzes, and resolves complex appeals. Effectively responds to customers in writing including explanations and a summary of actions to be taken. Advises the management of inquiry related activities that require a course of action to enhance customer/provider satisfaction.
Demonstrates proven ability to perform all service functions at the highest level with the highest degree of proficiency, as well as the ability to achieve a higher level of competence at their cross functional ability to perform in another area of service expertise to include claims adjudication, complex claims adjustments, processing of email and written correspondence and handling of walk-in clients.
Use knowledge of products and the contractual provisions that govern administration to provide effective customer service and education, to interpret contractual language to client 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 a client within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments. Appropriately documents of all client interactions according to established departmental procedures.
Prior Customer support role or call center experience.
HS Diploma or equivalent.
Generally 2-3yrs. experience.
Consistently higher customer satisfaction; defined in each division such as Cstat.
Completion of predetermined list of internal/external classes to develop skills required.
Proven track record of over-achieving standards Exceed personal and / or team qualitative & quantitative targets.
Strong CRM systems and practices in place.
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; Written Communication; Technical Skills
Proficient with products, systems and business decision making, analytical skills, detailed oriented and problem solving skills, de-escalation skills and capable of understanding and communication complex concepts.
Proactive and anticipatory of the customer’s needs, and responsible for member experience and retention, effective business writing skills, social media acumen, business savvy and capable of understating and communicating complex concepts
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.
2-4 yrs. college.
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: 4.30.21
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