Customer Service Advocate

Blue Cross and Blue Shield of North Carolina; United States; Remote; USD 42,000 - 67,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off (PTO)

Competitive health benefits

Job summary

Blue Cross NC is actively seeking a customer service expert to engage with members, employer groups, and providers through phone and chat, resolving benefits and eligibility questions. The role emphasizes education, training sessions, and driving self-sufficiency in using online tools.

Candidates should have a high school diploma and 3+ years in related fields. A strong focus on customer satisfaction, multi-channel support, and continuous improvement is essential.

Qualifications

• High school diploma or GED required.
• 3+ years of experience in related field.

Responsibilities

• Engage with providers, billing, and case managers to resolve customer concerns and educate on benefits, claims and eligibility.
• Provide customer education by conducting training sessions at employer sites and online sessions.
• Support ongoing complex customer inquiries such as those with serious health conditions and complex claims/benefit issues.
• Screen members to determine case management needs while using additional resources as needed.
• Adjust simple/routine claims as needed (for Provider only).
• Provide multi omni-channel inbound and outbound inquiry support.
• Interact with member/provider using probing and creative problem-solving techniques for diagnosis and issue resolution.
• Assist customers in navigating our online and mobile tools and guide them to self-sufficiency.
• Guide customers to make best healthcare decisions by educating them on plan selections, value of benefits, and choosing quality providers.
• Be a driver for new ideas and continuous process improvement.
• Engage with local, state and federal government entities and plan participants regarding our products, services and policies.
• Serve as subject matter expert or mentor to team members for non-routine inquiries.
• Leverage analytical skills to query, analyze and interpret data to address customer and business needs.

Skills

Active Listening

Client Issue Resolution

Customer Care

Customer Education

Customer Engagement

Customer Satisfaction

Customer Service

Customer Service Operations

Key Customer Management

People Management

Education

High School Diploma or GED

Job description

Embodies the service vision, objectives, and values of the organization by acting as a service expert for Blue Cross NC customers, employer groups and providers.

Strengthens the Blue Cross NC brand by developing, managing, and expanding customer relationships at service levels that meet and exceed customer expectation

Accurately, promptly, and professionally respond to members, employer groups, providers and other stakeholders. Strives to obtain customer satisfaction and first contact resolution while meeting the demand of members through all channels including phone and chat.

What You’ll Do

• Engage with key stakeholders such as providers, billing, and/or case managers to resolve customer concerns and educate customer on their benefits, claims and eligibility
• Provide customer education by conducting training sessions at employer sites and facilitating online sessions
• Support ongoing complex customer inquiries such as those with serious health conditions and complex claims/benefit issues
• Screen members to determine case management needs while using additional administrative or clinical resources as needed
• Adjust simple/routine claims as needed (for Provider only)
• Provide multi omni-channel inbound and outbound inquiry support
• Interact with member/provider using probing and creative problem-solving techniques for diagnosis and issue resolution
• Assist customers in navigating our online and mobile tools while encouraging and guiding them towards becoming self-sufficient in using them
• Guide customers to make the best health care decisions by educating them on topics such as understanding benefit plan selections, maximizing the value of their health plan benefits, and choosing a quality care provider
• Educate customers on their next best options and provide education so that the member can make the best decision to for their health
• Be a driver for new ideas and innovation while being an advocate for continuous process improvement
• Engage with local, state and federal government entities and plan participants regarding our products, services and policies
• Serve as subject matter expert or mentor to team members for non-routine inquiries
• Leverage analytical skills to query, analyze and interpret data to address customer and business needs

What You Have

• High school diploma or GED
• 3+ years of experience in related field.

Bonus Points

• Proven, hands-on Facets experience
• Strong customer/member service orientation.
• Knowledge of benefits and eligibility.
• Strong claims knowledge, including the ability to review a claim, connect the claim to applicable benefits
• IPP experience is preferred but not required

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

• Annual Incentive Bonus*
• 401(k) with employer match
• Paid Time Off (PTO)
• competitive health benefits and wellness programs.

$41,600.00 - $66,561.00

Skills

• Active Listening
• Client Issue Resolution
• Customer Care
• Customer Education
• Customer Engagement
• Customer Satisfaction
• Customer Service
• Customer Service Operations
• Key Customer Management
• People Management