Fully Remote - Customer Service Professional I
Open to all applicants within - WA, OR, ID and UT
Position starts: Monday, August 16th and Monday, August 23rd
Recruiter will reach out and discuss hours of operations and pay
Primary Job Purpose
The Customer Service Professional I provides information, education and assistance to members, providers, other insurance companies, attorneys, agents/brokers or other customer representatives on recorded phone lines regarding benefits, claims and eligibility. They also provide excellent and caring services to all internal and external members and providers.
The Customer Service Professional I is likely to be the primary contact between the corporation and members and providers. The manner in which a member or provider is treated during that contact is critical to retaining our customers and to the overall success of the corporation.
General Functions and Outcomes
- Successfully complete training period and meet dependability, timeliness, accuracy, quantity, and quality standards as established by department. Study, review and learn information, procedures and techniques for responding to a variety of inquiries.
- Communicate with a variety of subscribers, providers, healthcare providers, agents/brokers, attorneys, group administrators, other member representatives, internal staff and the general public with inquiries regarding benefits, claim payments and denials, eligibility, decisions, and other information through a variety of media - oral, written and on-line communications. Respond to multiple inquiries on all designated lines of business.
- Quickly and accurately assess provider and member inquiries and requirements by establishing a rapport inquirer in order to understand his/her service needs. Identify errors promptly and determine what corrective steps may be taken to resolve errors.
- Apply benefits according to appropriate contract. Determine benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.
- Make appropriate corrections of denied, process-in-error or re-classified claims.
- Explain benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to members and providers to ensure that benefits, policies and procedures are understood.
- Educate members and providers on confusing terminology and policies such as eligible medical expenses, hold harmless, medical necessity, contract exclusions and limitations, and managed care products.
- Maintain confidentiality and sensitivity in all aspects of internal and external contacts.
- Manage high volume of calls on a daily basis, prioritize follow-through and document member and provider inquiries and actions on tracking system and/or by completing logs. May generate written correspondence and process document requests.
- May provide face-to-face member and provider service and education in a lobby setting or walk-up counter using a PC. Assist individual, Medicare and other applicants in completing their applications and answering any questions they may have. When required, may maintain a cash drawer and ensure that it balances each day.
- Maintain files/records of constantly changing information regarding benefits/internal processes including company-wide internal policies and benefit updates for new or existing business. Work is subject to audit/checks and requires considerable accuracy, attention to detail and follow-through.
- Comply with NMIS/MTM and Consortium standards as they relate to the employee's responsibility to meet BlueCross BlueShield Association (BCBSA) standards and corporate goals.
- Assist in identifying issues and trends to improve overall customer service.
- For HMO related work: Enter, correct and adjust referrals according to established policies and procedures. Explain referral rules, processes to providers and internal customers.
Normally to be proficient in the competencies listed above
- Keyboarding skills of 30 wpm with 95% accuracy.
- Proficient PC skills and prior experience in a PC environment.
- Demonstrated knowledge of medical terminology and coding preferred.
- Ability to apply mathematical concepts and calculations.
- Ability to communicate effectively orally and in writing with understanding and ability to apply correct punctuation, spelling, grammar and proof-reading skills.
- Demonstrated ability of strong customer-service skills, including courteous telephone etiquette.
- Ability to make decisions and exercise good judgment in a complex and rapidly changing environment.
- Ability to adapt to a fast-paced environment and learn, retain, and interpret new or evolving information, procedures, and policies and communicate them effectively.
- Ability to work under stress and pressure and respond to inquiries with tact, diplomacy and patience.
- Ability to work in a team environment.
- Ability to exercise discretion on sensitive and confidential matters.
- Demonstrate initiative in researching and resolving benefit, and eligibility issues.
- This is a full-time and permanent remote position
Customer Service Professional I would have a high school diploma or equivalent and 1 year customer service call center experience or 1 year customer service experience such as insurance, retail, banking, restaurant, hospital medical office or other experience with extensive customer service contact or equivalent combination or education and experience.
- Work primarily performed in office environment.
- May be required to work overtime.
- May be required to work outside normal hours.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com