Member Customer Service Representative

Premera Blue Cross; Atlanta (GA); Remote; USD 39,000 - 58,000; Full time

Benefits offered by this job

Tuition assistance

Healthcare benefits starting day one

401(k) matching

Paid time off

Job summary

Premera Blue Cross is seeking a Remote Customer Service Representative II to deliver inbound and outbound service, achieving first-call resolution from a home-based setting across states including Georgia. The role emphasizes empathy, accuracy, and timely information exchange, supported by comprehensive training and benefits.

Expect to resolve claims status questions, route complex inquiries to the appropriate department, and document all member interactions while maintaining HIPAA-compliant

Qualifications

• Two years of customer service experience required.
• Ability to defuse conflicts with empathy and respect.
• Proficiency with Microsoft Office and navigating multiple screens.

Responsibilities

• Provide inbound and outbound customer service with first-call resolution.
• Research, escalate, and document member inquiries accurately.
• Maintain privacy and handle PPI according to HIPAA.

Skills

Empathy

Communication

Multi-tasking

Microsoft Office

Education

Two years college coursework

Tools

Microsoft Office Suite

Job description

Workforce Classification:

Telecommuter

Join Our Team: Do Meaningful Work and Improve People’s LivesOur purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for.

Learn more about our recent awards and recognitions as a greatest workplace.Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:

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Additional Job DescriptionPremera is committed to making healthcare work better, and it all starts with the Customer Service Representative. To help us continue to provide the best support for our customers, Premera is hiring additional Customer Service Representatives based out of Eastern Washington, Idaho, Oregon, Montana, Utah, Minnesota, Wisconsin, Tennessee, North Carolina, South Carolina, Georgia, Florida, Texas, and Arizona areas.As a Customer Service Representative, you play an essential role in ensuring that the customers we serve are provided with a first call resolution.The Customer Service Representative II (CSR II) plays an essential role in ensuring that the members and providers that Premera serve are provided with a first call resolution. Through applying Premera’s core values and competencies, the CSR II provides inbound and outbound customer service support while ensuring delivery of accurate, complete, and timely information. CSR II conducts research to provide claims status, investigates routine questions, escalates all call issues as required and thoroughly documents all member interactions. CSR II serves both Premera members and providers which includes doctors, facilities (clinics, hospitals, skilled nursing facilities, etc.), and vendors for multiple geographic locations.

What you will love:

• Set schedule with consistency – Monday through Friday, 8-hour shift between 5 a.m. and 8 p.m. Pacific Time.
• Twelve weeks of paid virtual training (100% attendance required).
• Work from home, full time (40-hour week).
• Upon successful graduation of the 12-week training class, Premera will provide a one-time pre-tax allotment of $500 (minus taxes) towards home office furniture.
• A comprehensive benefits package that is designed to promote health and well-being. We offer an employer matched 401k, pension equity plan, and healthcare benefits. Healthcare benefits start day one. Premera offers a generous PTO policy in addition to 8 paid days off a year plus two floating holidays.
• Tuition assistance for both undergraduate and graduate level classes.
• Opportunities for RISE recognition. RISE, Premera's employee recognition program, is designed to celebrate colleagues' work, reinforce core competencies, and provide redeemable rewards.
• A nationally recognized workplace as one of the best companies to work for that nurtures an employee culture where everyone can thrive.

What you will do:

• Accountable for inbound and/or outbound phone-based customer service; provides first call and/or email resolution, de-escalate calls, as well as provides caller education, through clear and accurate exchange of information.
• Follow-up, resolve and document issues in a timely manner. Route inquiries needing further investigation to the appropriate department and conduct routine research as needed.
• Follow up on pended items and route incoming paperwork to correct departments for completion.
• Work with highly sensitive information while maintaining Personal Protected Information (PPI) requirements.
• Performs with reliable and consistent behaviors, performance goals and metrics, and attendance.
• Other duties as assigned.

What you will bring:

• High School Diploma or GED. (Required)
• Two years of customer service experience in related fields (Required) which includes the following:
  • Ability to defuse conflict and address customer concerns effectively with empathy and respect.
  • Demonstrated recent experience with Microsoft Office Suite or equivalent software platforms, including proficiency in navigating multiple screens and systems simultaneously while providing live call support.
  • Demonstrated ability to accept constructive feedback, adapt work practices accordingly, and implement changes to improve performance.
  • Ability to adapt communication style to broad audiences.
  • Ability to work a variety of shifts based on quality metrics (if shift bid applies).
• Two (2) years of college coursework or three (3) years of work experience in customer service. Experience in:
  • Healthcare, insurance, benefits, and/or claims processing industries.
  • Call centers with high volume inbound/outbound calls.
  • Recorded screen settings.
  • High volume metrics and audited work.

What you will gain:

• Deep healthcare and insurance knowledge, and an understanding of the provider ecosystem by working with clinics, hospitals, and vendors, and understanding their needs.
• Regulatory and compliance awareness, including the handling of Personal Protected Information (PPI) and HIPAA-related practices.
• Daily use of ALICE, Premera’s AI-powered virtual agent, to access procedures and guidance.
• Career progression pathways: CSR roles feed into many other operations roles, evidenced by nearly 70% of promotions in Operations coming from Customer Service.

Physical Requirements:

The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation:This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard, to communicate and to receive detailed information through verbal communication clearly and understandably in person, and over the telephone

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at or via phone at .

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.The salary range for this role is posted below; we generally target up to and around the midpoint of the range.National Salary Range:$38,500.00 - $57,800.00

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.