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 & 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 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.
Delivers accurate information to customers in accordance with performance goals and objectives.
Maintains customer records by updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.
Participates in ongoing education related to new services, industry topics, and skills.
QUALIFICATIONS:
Education Level: High School Diploma or GED
Experience: less than one year customer service experience.
Knowledge, Skills and Abilities (KSAs)
Department
Department: MD Medicaid -MEMBER SERVICES
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
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
#LI-LY1
Job Description At KPMG, you can become an integral part of a dynamic team at one of the world’s top...
Apply For This Jobbr{display:none;}.css-58vpdc ul > li{margin-left:0;}.css-58vpdc li{padding:0;}]]> If you are: naturally curious interested in and good at solving challenging problems a happy...
Apply For This JobJob Description Current Living Spaces Employees: Please apply via your internal Workday Account. At Living Spaces, we take pride in...
Apply For This Jobbr{display:none;}.css-58vpdc ul > li{margin-left:0;}.css-58vpdc li{padding:0;}]]> Xtend Healthcare, a Navient company, is nationally recognized as the industry-leading provider of comprehensive revenue...
Apply For This JobPrimary Purpose This position is responsible for the accounting of commodity transactions in support of Sempra Infrastructure business units. This...
Apply For This JobJob Description We are looking for an experienced and dynamic Senior Tax Consultant to join the Professional Services team. In...
Apply For This Job