Member Service Representative II (Hybrid)

CareFirst BlueCross BlueShield; Washington (District of Columbia); On-site; USD 39,000 - 71,000; Full time

Job summary

CareFirst BlueCross BlueShield in Washington, DC seeks a Rep, Member Service II to handle complex benefits, claims, and general inquiries with broad knowledge of systems, contracts/products, and procedures. You will resolve issues and assist with enrollment and billing processes for diverse clients.

You will support training of new hires, collaborate with clinical professionals on care interventions, and respond to inquiries from internal and external customers with professionalism and accuracy.

Qualifications

• Education level: High School Diploma or GED.
• Experience: 3 years customer service, claims, inbound call center experience.
• Preferred qualifications include exposure to health care, health insurance, medical information, and direct service experience.

Responsibilities

• Answers complex member inquiries by clarifying desired information; researching, locating, and providing information.
• Resolves complex member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
• Examines claims to identify key elements, and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures.
• Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments, and managed care processes.
• Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other BCBS Plans.
• Learns the details of offering and administering various billing transactions, i.e. direct pay, credit card payment, and debit accounting through the policyholders checking account, and how to effectively interact with or advise clients, group administrators, brokers, or providers on problem resolution.
• Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.
• Assist with training of new hires.

Skills

Organizational skills

Interpersonal skills

Problem solving

Communication skills

Customer issue resolution

Deadline management

Education

High School Diploma or GED

Job description

Resp & Qualifications

The Rep, Member Service II is responsible for complex benefits, claims, and general inquiries. They have broader knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry.

Purpose

The Rep, Member Service II is responsible for complex benefits, claims, and general inquiries. They have broader knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry.

Resp & Qualifications

The Rep, Member Service II is responsible for complex benefits, claims, and general inquiries. They have broader knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry.

Essential Functions

• Answers complex member inquiries by clarifying desired information; researching, locating, and providing information. Resolves complex member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
• Examines claims to identify key elements, and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures. Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments, and managed care processes.
• Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other BCBS Plans. Learns the details of offering and administering various billing transactions, i.e. direct pay, credit card payment, and debit accounting through the policyholders checking account, and how to effectively interact with or advise clients, group administrators, brokers, or providers on problem resolution.
• Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.
• Assist with training of new hires.

Qualifications

Education Level: High School Diploma or GED.

Experience: 3 years customer service, claims, inbound call center experience.

Preferred Qualifications

• Experience performing duties that are detailed in nature, exposure to health care, health insurance, medical information, and direct service experience is preferred.

Knowledge, Skills And Abilities (KSAs)

• Self-starter with strong organizational skills and planning skills.
• Ability to maintain effective interpersonal relationships.
• Ability to recognize, analyze, and solve a variety of problems.
• Excellent communication skills both written and verbal.
• Resolves customer concerns by obtaining information from customer service representative; calling customer back with new information.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range:

$38,520 - $70,620

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship