Complaint Tracking Module- Service Specialist

Independence Blue Cross, LLC in; Philadelphia (Philadelphia County); Hybrid; USD 42,000 - 65,000; Full time

Job summary

Independence Blue Cross is seeking a Complaint Tracking Module- Service Specialist to investigate and resolve Medicare Advantage member complaints. You will advocate for members, respond to inquiries, and document all interactions within our systems.

The role requires strong communication, empathy, and the ability to manage multiple tasks in a fast-paced environment. Hybrid work is available; some in-office and remote work within the Tri-State Area may be required.

Qualifications

• Minimum 1–2 years related work experience in a Contact Center or Customer Service environment.
• Insurance knowledge or experience with Medicare Advantage/Medigap is a plus.
• Experience handling member inquiries with empathy and professionalism.

Responsibilities

• Investigates and resolves Medicare Advantage member complaints per CMS SOPs and internal CTM policies.
• Acts as member advocate and responds to complaints promptly.
• Documents all interactions in internal systems.
• Communicates with internal/external resources to coordinate investigations.
• Ensures timely determinations per CMS guidelines and files case documents correctly.

Skills

Customer service

Active listening

Communication

Problem solving

Tools

Microsoft Office

Job description

Complaint Tracking Module- Service Specialist

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Responsibilities

• Investigates and resolves all facets of Medicare Advantage member complaints received via 1-800-MEDICARE based on the standard CMS Standard Operating Procedure and internal policies for the Complaint Tracking Module (CTM).
• Serves as the member’s advocate and responds to member complaints and inquiries in a timely manner.
• Documents all interactions related to member complaints within appropriate internal systems.
• Communicates effectively and professionally with internal department and external resources to coordinate and to investigate the member(s) complaint(s).
• Ensures all determinations are effectuated timely and in compliance with CMS guidelines.
• Ensures case file documents are filed and secured based on unit guidelines and are submitted timely for Q/A purposes.
• Organizes and confirms all pertinent documentation is included in case files for both internal and external (CMS) audits.
• Investigates, completes member outreach and documents assigned for escalated Medicare Advantage and Medigap member issues outside of the CTM process in a thorough and timely manner.
• Close the Loop in all interactions.
• Work extended hours to ensure business, compliance and the immediate needs of the member are met. This includes a Friday evening team rotation through 5pm, and weekends/corporate holidays as needed.
• Performs other duties as assigned.
• Minimum 1 – 2 years related work experience within a Contact Center or Customer Service environment.
• Insurance License a plus
• Medicare Advantage and Medigap experience preferred
• Effective listening and empathy skills, and the ability to assess and address member needs while providing appropriate member expectations.
• Demonstrated experience dealing effectively with both calm and irate members and/or their representative(s).
• Maintains a high level of customer focus in all interactions through the Independence Customer Service Principles.
• Excellent telephone, proofreading and written communication skills required.
• Effectively manage and prioritize multiple assignments with overlapping deadlines under limited supervision.
• Work effectively with a sense of urgency in a fast-paced environment – generally under time constraints.
• Be focused, detail-oriented, and have excellent analytical, critical thinking and problem-solving skills.
• Develop and maintain positive working relationships with internal and external resources.
• Skilled in identifying and solving issues and recommending/documenting process improvements.
• Demonstrated ability to handle complex member issues.
• Proficiency in the use of Microsoft Office (Word, Excel).
• Ownership and results driven.

Ability to work from home, which includeshigh-speed wi-fi capability of at least 400 Mbpsand a quiet, confidential workspace.

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania

Independence Blue Cross is an Equal Opportunity and affirmative action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com . We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.