FEP Customer Service Representative

Capital Blue Cross is hiring a FEP Customer Service Representative to provide timely, professional service to members, providers, group administrators, brokers, and other stakeholders. The role researches and resolves inquiries about enrollment, billing, benefits, and claims, and supports Marketing in servicing accounts.

Responsibilities:

• Customer Service Representative is responsible for providing efficient, courteous, professional quality service to members, providers, group administrators, brokers, Plan personnel, and the general public in a timely manner. Inquiries are received via telephone, Fax, written correspondence (Imaging), E-mail, E-messenger Internet, and personal interviews. Inquiries cover topics pertaining to enrollment, billing, benefits, and claims for various types of coverage offered by CBC. Provides support for the Marketing department, serving as a liaison for group administrators, brokers, and assisting in servicing accounts
• Receives incoming inquiries via telephone, correspondence, on-site, Fax, Internet, E-mail and personal interviews from individual customers, group administrators, providers, Capital BlueCross personnel, Host Plan personnel, attorneys, and outside entities working on the customer's behalf
• Researches and analyzes the customer's inquiry. Determines appropriate action by reviewing and interpreting applicable policies/procedures. Utilizes the PC, manuals, Image, etc., to obtain benefits, enrollment and claim information
• Ensures the satisfactory resolution of routine and moderately complex inquiries (e.g., Blue Card) benefits, claim filing and processing, collection issues, enrollment discrepancies, legal requests, Medicare Secondary Payor, Plus Billing and payment requests, Third Party Administrators, COBRA, reinstatements, conversions, refunds, new enrollment, transfer situations, student certifications, handicapped dependents) for all lines of business administered and supported by Capital BlueCross
• Provides clear and concise instructions to the appropriate Plan area, in the approved format (e.g., electronic, on-line or hard copy forms, telephone contact) for the resolution of the issues
• Contacts the appropriate internal/external entities (e.g., groups, providers, Marketing, Legal, host plans) to obtain information and initiate necessary action
• Responds to customers, verbally or in writing, with accurate and timely information
• Monitors inquiries for accurate and timely resolution to ensure customer satisfaction and compliance with MTM quality and timeliness guidelines
• Enters all information necessary to update the Facets system, or Inquiry Control System when appropriate, for tracking inquiry action and status. Utilizes the system to obtain background information and prevent duplication of effort
• Reports inquiry trends to management that may indicate processing problems, lack of documentation or appropriate information concerning claims, enrollment areas, benefits, policies and procedures
• Assists/participates with Marketing personnel and the broker community in the support of customer needs by researching and communicating information to other Plan personnel or directly to the customer. May attend or participate in marketing related activities as a representative of Capital BlueCross Customer Service (e.g., health fairs, seminars, open enrollment, and on-site visits)

Requirements:

• Must have a high school diploma or G.E.D
• 1 year customer service experience
• Demonstrates ability to understand and interpret detailed policies and procedures and to be able to apply them to various situations. This includes thorough understanding of CBC's responsibility to maintain privacy of Protected Health Information as required by the Health Insurance Portability and Accountability Act
• Demonstrates ability to work independently, be flexible and react appropriately to changing job assignments and work environments
• Demonstrates ability to communicate effectively and professionally both verbally and in writing with all levels of internal/external personnel in order to respond to customer inquiries ranging from routine to complex and involving sensitive subject matter
• Demonstrates analytical, organization and problem solving skills in order to accurately and efficiently identify, analyze and respond to customer inquiries, as well as identify and analyze trends and discrepancies
• Ability to use telephone equipment systems such as Interactive Voice Response and Automated Call Distribution
• Familiarity with the utilization of a PC and various software such as Microsoft Office Suite