Department - 125460 BCN Commercial / Mail Code: C225
Salary Grade - UF
Job Code - C1C
Number of Openings – 15
Start Dates: 11/15/21
Status – regular FT
Shift- 8:00 am – 5:30 pm (M-F)
Site- Southfield
Assessment required for consideration: Customer Service Rep
Investigate, process, resolve, and respond to member, provider or beneficiary inquiries received via telephone, written correspondence or in person.
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.
Direct and/or adjudicate claim-related inquiries.
Initiates status reports or service recovery letters to the inquirer when delays occur in responding to an inquiry as required.
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.
Document each contact through (BCN�s Customer tracking/imaging/workflow system).
Record pertinent facts regarding inquiries, and update appropriate files.
Update membership information following customer services guidelines (this includes PCP changes, address changes, and ordering of ID cards).
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.
Perform other related duties as assigned by Customer Services leadership.
" Qualifications"
High school graduate or GED equivalent.
Must pass testing requirements if applicable as identified by Talent Acquisition.
Two (2) years of customer service experience with personal contact required.
Experience in medical claims reimbursements or medical billing preferred.
Knowledge of microcomputers and PC software application required.
Knowledge of Customer Service techniques preferred.
Demonstrated knowledge of health care policies, procedures, BCNM certificates, riders and benefits as related to inquiry processing preferred.
Conversant in HMO/Health insurance industry terminology preferred.
Knowledge of BCN/BCBSM systems and operations preferred.
Knowledge of Call Center and Imaging technology preferred.
Knowledge of MDCH, NCQA, and MTM/NMIS guidelines and requirements preferred.
Must be able to demonstrate highly developed verbal and written communication skills.
Demonstrated professional servicing skills.
Highly organized, motivated, responsible self-starter, with excellent time management, analytical and problem solving skills.
Personal computer skills required.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
