Customer Service Representative II - Lansing

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Lansing, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: summary,performance,compliance,investigate,support,reporting,knowledge,experience,education,quality assurance,organization,professional

Full-Time

Competitive Total Compensation Package

Overview: <div>Investigate, process, resolve, and respond to member, provider, or beneficiary inquiries received via telephone, written correspondence, or in person.</div>
Responsibilities: <ul> <li>Investigate, process, resolve, and respond to member, provider or beneficiary inquiries received via telephone, written correspondence or in person regarding benefits, eligibility, materials forms, ID cards, PCP changes, complex inquiries and quality care issues.</li> <li>Direct and/or adjudicate claim-related inquiries.</li> <li>Initiates status reports or service recovery letters to the inquirer when delays occur in responding to an inquiry as required.</li> <li>Reroute misdirected inquires. Educate new and existing members, providers, or beneficiaries concerning BCN policies and procedures and specific benefits through welcome calls and daily telephone inquiries and written correspondence.</li> <li>Document each contact through (BCNs Customer tracking/imaging/workflow system).</li> <li>Record pertinent facts regarding inquiries, and update appropriate files.</li> <li>Update membership information following customer services guidelines (this includes PCP changes, address changes, and ordering of ID cards).</li> <li>May assist other representatives in handling unusual complex inquiries, including irate calls as well as those inquiries that may have complications for the retention of business.</li> <li>Perform other related duties as assigned by Customer Services leadership.</li> </ul>
Requirements: <ul> <li>High school graduate or GED equivalent.</li> <li>Must pass testing requirements if applicable as identified by Talent Acquisition.</li> <li>Two (2) years of customer service experience with personal contact required.</li> <li>Experience in medical claims reimbursements or medical billing preferred.</li> <li>Knowledge of microcomputers and PC software application required.</li> <li>Knowledge of Customer Service techniques preferred.</li> <li>Demonstrated knowledge of health care policies, procedures, BCNM certificates, riders and benefits as related to inquiry processing preferred.</li> <li>Conversant in HMO/Health insurance industry terminology preferred.</li> <li>Knowledge of BCN/BCBSM systems and operations preferred.</li> <li>Knowledge of Call Center and Imaging technology preferred.</li> <li>Knowledge of MDCH, NCQA, and MTM/NMIS guidelines and requirements preferred.</li> <li>Must be able to demonstrate highly developed verbal and written communication skills.</li> <li>Demonstrated professional servicing skills.</li> <li>Highly organized, motivated, responsible self-starter, with excellent time management, analytical and problem solving skills.</li> <li>Personal computer skills required.</li> </ul> <div id="gtx-trans" style="position: absolute; left: -83px; top: 26px;">&nbsp;</div>