Member & Provider Service Rep - Southfield

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.

Southfield, 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: position summary,compliance,investigate,knowledge,skills,education,teamwork,quality assurance,experience

Full-Time

Competitive Total Compensation Package

Overview: <div>Responsible for properly handling all telephone, written, and walk-in inquiries. Investigate, research, process, resolve and respond to member, provider, and agent inquiries. Update membership information following customer service guidelines. Educate new and existing members and providers concerning BCN Advantage policies/procedures and benefits through telephone inquiries.</div>
Responsibilities: <ul> <li>Investigate, process, resolve and respond to member, provider, or agent inquiries received via telephone, written correspondence, or in-person regarding benefits, eligibility, material forms, ID cards, PCP changes, claims, complex inquiries, and quality of care issues.</li> <li>Initiates status calls to the inquirer when delays occur in responding to an inquiry as required. Reroute misdirected inquiries.</li> <li>Educate new and existing members, providers, or agents concerning BCN Advantage policies, procedures, and benefits through daily telephone inquiries.</li> <li>Documents each contact through BCN's customer tracking/imaging/workflow system.</li> <li>Documents pertinent facts regarding inquiries, and update appropriate files.</li> <li>Update membership information following BCN Advantage member services guidelines.</li> <li>Maintain positive relationships and interactions with employees, enrolled members, potential members, providers, employer groups, and vendors</li> <li>Special projects and other duties as assigned.</li> </ul>
Requirements: <ul> <li>High School Graduate or GED equivalent is required.</li> <li>Two (2) years of customer service experience with personal contact required</li> <li>Must pass testing requirements if applicable as identified by Talent Acquisition</li> <li>Excellent organizational skills with the ability to handle multiple projects and timelines required</li> <li>Highly motivated and responsible self-starter required.</li> <li>Ability to work effectively independently and in a team environment required.</li> <li>Excellent verbal and written communication skills required.</li> <li>Excellent interpersonal skills including the ability to interact with internal and external customers and all levels of the organization required.</li> <li>Extensive knowledge of customer servicing techniques required.</li> <li>Basic knowledge of Microsoft Word and Excel required.</li> <li>Strong analytical and decision-making ability required.</li> <li>Demonstrated knowledge of health care policies, procedures, certificates, riders and benefits as related to inquiry processing preferred.</li> <li>Demonstrated knowledge of CMS rules and regulations and Medicare benefits, policies and procedures preferred.</li> <li>Knowledge of Medicare program and how it relates to managed care preferred.</li> <li>Familiar with all healthcare systems and operations interfaces 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>Knowledge of procedure codes and the process for adjudicating routine claims inquiries preferred.</li> </ul> <div id="gtx-trans" style="position: absolute; left: -312px; top: 26px;">&nbsp;</div>