Blue cross blue shield customer service representative job description

Job Description Summary: Staffs the Regional Member Center. Performs customer service representative and other office functions as assigned by management. Job Description: GENERAL PURPOSE Staffs the Regional Member Center. Performs customer service representative and other office functions as assigned by management. ESSENTIAL DUTIES/RESPONSIBILITIES [Core 25d]  Works towards quality initiatives.  Answers telephone inquiries and provides service for walk in customers.  Schedules sales and renewal appointments for sales staff.  Prepares proposals for sales staff as required.  Provides service to members, both group and individuals.  Responsible for the administration and completion of group compliance paperwork.  Performs routine administrative functions such as business correspondence, filing, supply inventory, etc.  Attends training programs and meetings as required. OTHER DUTIES/RESPONSIBILITIES Other duties as assigned. SUPERVISORY DUTIES None. JOB QUALIFICATIONS KNOWLEDGE, SKILL & ABILITY: [Core 25b] Must be professional and enjoy working with people. Must have good telephone skills. Must become knowledgeable about Blue Cross Blue Shield of Wyoming and its insurance products. Must have demonstrated proficiency in the use of word processing, data base, and spread sheet programs. Must have good typing skills and be able to compose professional business correspondence. EDUCATION, LICENSURE, OR FORMAL TRAINING: [Core 25a & 25c] High School diploma or equivalent. Current, valid driver’s license may be required. EXPERIENCE: [Core 25a] One to three years of work experience (typically in customer service). MATERIAL AND EQUIPMENT DIRECTLY USED: Personal Computer and associated word processing, data base, and spread sheet programs. WORKING ENVIRONMENT/PHYSICAL ACTIVITIES: Works in an open office environment. Job activities include effective interaction with the public, writing, typing, use of the telephone, and some travel by automobile (depending on the location of the office). The ability to handle occasionally stressful situations is also required. ACCESS TO PROTECTED HEALTH INFORMATION (PHI) Access to Protected Health Information (PHI) will be limited to that which is necessary to carry out job duties outlined above. Blue Cross Blue Shield of Wyoming is an EOE, M/F/Vet/Disabled employer. Blue Cross Blue Shield of Wyoming uses E-Verify to confirm employment eligibility. Equal Opportunity is the Law EEO is the Law Supplement IER Right to Work FMLA E-Verify Pay Transparency

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Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. ® Registered Marks of the Blue Cross and Blue Shield Association. ®´ Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. ®´´ Registered Marks, TM Trademarks. and SM Service Marks are the property of their respective owners. © 2020 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.

Job Description

Description

Analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines.

• Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.
• Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters.
• Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).
• Organize work to meet National/Corporate/Department Production and Quality Standards.
• Reroute misdirected inquiries.
• Primarily evaluates membership issues/inquiries and price/adjudicates low complexity claims/inquiries.
• Interact with others inside and outside the organization to resolve the inquiry/claim related problems.
• Influence customers to accept the reasonableness of decisions and actions.
• Other duties may be assigned.

Qualifications

Education and Experience

• High school graduate or GED equivalent.
• One (1) year of related work experience in areas such as public/customer service, sales representative, claims processing, membership enrollment or one (1) year of public contact in positions such as teaching, social service work, bank teller, medical assistant/office assistant.
• One (1) year of total related experience or in the absence of internal BCBSM experience, the following may apply: One (1) year of related work experience in areas such as public/customer service, sales representative or claims processing.
• Demonstrated knowledge of policies, practices and procedures related to membership.
• Demonstrated ability to analyze data and resolve problems related to membership.
• Demonstrated command of all skills necessary for oral and written communications in a clear, concise and tactful manner.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, protected veteran status or status as an individual with a disability.

Job: Operations

Primary Location: Detroit

Organization: Service Operations-7103

Schedule: Full-time

Req ID: MED0005S

This job was posted on Wed Aug 05 2020 and expired on Sat Aug 22 2020.

Minimum $22K/yr

$31K/yr Average

Maximum $54K/yr

Tasks

• Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.
• Check to ensure that appropriate changes were made to resolve customers' problems.
• Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
• Resolve customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills.
• Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers.
• Refer unresolved customer grievances to designated departments for further investigation.
• Determine charges for services requested, collect deposits or payments, or arrange for billing.
• Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
• Solicit sales of new or additional services or products.
• Order tests that could determine the causes of product malfunctions.
• Obtain and examine all relevant information to assess validity of complaints and to determine possible causes, such as extreme weather conditions that could increase utility bills.
• Review claims adjustments with dealers, examining parts claimed to be defective, and approving or disapproving dealers' claims.
• Review insurance policy terms to determine whether a particular loss is covered by insurance.
• Compare disputed merchandise with original requisitions and information from invoices and prepare invoices for returned goods.
• Recommend improvements in products, packaging, shipping, service, or billing methods and procedures to prevent future problems.

Skills

• Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
• Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Speaking - Talking to others to convey information effectively.
• Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Persuasion - Persuading others to change their minds or behavior.
• Service Orientation - Actively looking for ways to help people.

Knowledge

• Clerical - Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
• Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
• English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Blue Cross Blue Shield of Michigan

Description

Established in 1939, Blue Cross Blue Shield of Michigan is a leading non-profit mutual insurance company serving 4.5 million individuals in Michigan and 1.6 million+ in other states. The Detroit, Michigan-headquartered company has 33,000+ doctors and 8,100+ employees working in 152 hospitals. The company is a trusted partner for its members by delivering innovative, cost-effective products that enhance their health and care. It builds its forte in designing, selling, and managing health benefit plans for Michigan-based employers, people, and families including, traditional plans, preferred provider organization (PPO) plans, medicare plans, wellness-based plans, dental and vision plans, and much more. Blue Cross Blue Shield of Michigan has been honored with numerous awards for its diversity and inclusion, cutting-edge health care programs, community leadership, and commitment to its customer experience. Recently, it has been awarded the 2020 J.D. Power Award. The company offers its people an award-winning culture with a scope to grow professionally.

Location

600 E. Lafayette Blvd.Detroit, MI, 48226and others

Industry

Insurance Agency & Brokerage Firms

Total job postings in the past

Based on 130 job boards, duplications excluded

3 weeks

Average posting lifetime

Total job posting distribution in the past

Based on 130 job boards, duplications excluded

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