Complaint Tracking Module- Service Specialist

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); Hybrid; USD 42,000 - 54,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Independence Blue Cross, LLC is seeking a detail-oriented member services professional to investigate and resolve Medicare Advantage and Medigap member complaints in a fast-paced call center environment.

The role supports member advocacy, documents interactions in internal systems, coordinates with internal/external resources, and adheres to CMS guidelines. The position follows a hybrid model with in-office and remote days in the TriState area.

Qualifications

• 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.
• Excellent telephone, proofreading and written communication skills.
• Proficiency in Microsoft Office (Word, Excel).

Responsibilities

• Investigates and resolves Medicare Advantage member complaints via 1800MEDICARE per CMS SOP and CTM policies.
• Acts as member advocate and responds to complaints and inquiries promptly.
• Documents all interactions related to member complaints in internal systems.
• Communicates with internal and external resources to coordinate and investigate complaints.
• Ensures timely determinations in compliance with CMS guidelines.
• Maintains case files for audits and ensures documentation is complete.
• Conducts member outreach for escalated issues and closes the loop in interactions.
• Works extended hours and follows hybrid work model with in-office and remote days.

Skills

Customer service

Written communication

Telephone skills

Microsoft Office

Tools

Microsoft Office Suite

Job description

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 wellbeing of the people and communities we serve.

Responsibilities

• Investigates and resolves all facets of Medicare Advantage member complaints received via 1800MEDICARE 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 fastpaced environment generally under time constraints.
• Be focused, detailoriented, and have excellent analytical, critical thinking and problemsolving 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 includes highspeed wifi capability of at least 400 Mbps and 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 TriState Area of Delaware, New Jersey or Pennsylvania.

Additional Requirements

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

Independence Blue Cross is an Equal Opportunity and Affimative 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.