Provides a world-class customer service experience by trouble shooting and resolving complex customer inquiries from members, employers, and providers.
Research, resolve and respond to inquiries and correspondence via telephone, written communication and/or in person. Inquiries will be from members, providers, group leaders and internal staff regarding a diverse range of topics including, but not limited to, contract benefits, changes in coverage, eligibility, claims, provider networks, payments and appeals.
Uses critical thinking skills to determine course of action needed to resolve inquiry or complaint.
Must be comfortable being monitored for level of efficiency, accuracy and customer satisfaction and must be able to meet performance standards to achieve both individual and department goals.
Must be able to communicate effectively with appropriate tone and content. Customer Service calls are recorded to ensure accuracy and to provide a tool for feedback for reps.
Must be able to balance workload to ensure timely and accurate response to both internal and external customers.
Initiate claims adjustments and update enrollment information through the on-line systems as determined necessary through inquiries.
Must demonstrate the ability to listen, talk, type and perform research simultaneously using various research channels, both online and hard copy.
Must be able to follow a call guide.
Ability to provide education to our members and providers on various avenues available to them to obtain information such as the website.
Promote good working relations and positive work environment while acting as a role model to coworkers.
Must remain positive, pleasant, and helpful under a wide variety of circumstances including angry customers. Employee must be able to be on telephone constantly except for breaks and lunches and must wear a headset that plugs into the phone. Communication by telephone and direct personal contacts will consume 95% of the workday. Must operate a Personal Computer (PC) at least 95% of the day in which a sitting/stationary position is required. While performing the duties of this job, the employee is regularly required to talk or hear. Is subject to work standards and must achieve and maintain a commendable performance level in production and quality with minimal supervision. Must be able to adhere to a very strict schedule to include varying start and stop times and when allowed to go to break/lunch.
High school education or its equivalent required. College or continuing education courses in communications, interpersonal relationships, psychology, anatomy, physiology, medical terminology, composition or business letter writing is preferred.
Working knowledge of Blue Cross and Blue Shield of Kansas customer service systems is required upon completion of training.
Detailed knowledge of contracts, benefit coding, enrollment regulations, and legal issues such as HIPAA, COBRA, OBRA, and MSP are required upon completion of training.
Excellent customer service skills, problem solving skills and organizational skills are required.
Must be comfortable working individually in a structured environment.
Proficiency in Grammar, Spelling, Typing and Basic Math are required.
Two year’s experience navigating multiple computer systems preferred.
Two year’s customer service experience preferred.
Excellent human relations and communication skills are required with the ability to interact positively with external customers and all levels of internal staff