Customer Service Representative

Purpose of the job

• This is a highly specialized customer service position with an emphasis on excellence, privacy, compliance and versatility within the health insurance industry. The position will identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
• Scope of the position includes accountabilities that support the following programs: 1. Utilization Management, 2. Member Relations and 3. Network Management.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

• 1 years of experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• Within 45 days of hire in member concierge, Mi Consejero Azul, or areas supporting sales, employee must hold an active, current, and unrestricted AZ Department of Insurance Health Insurance License

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

• 2 year(s) of experience in claim processing, customer service, call center, health insurance, medical office, or other healthcare-related field

• Associate's Degree in general field of study

• A valid Arizona driver license with an acceptable driving record if travel is required (e.g. regional employees)
• Active, current, and unrestricted AZ Department of Insurance Health Insurance License for member concierge, Mi Consejero Azul, or areas supporting sales

Preferred Certifications

• N/A

ESSENTIAL job functions AND RESPONSIBILITIES

• Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
• Answer a diverse and high volume of health insurance related customer calls and correspondence daily.
• Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
• Document and record facts in regard to inquiries and correspondence by updating BCBSAZ files and system.
• Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
• Utilization Management-related accountabilities for FEP staff include:
  • Review of healthcare service requests for completeness of information
  • Collection and/or transfer of non-clinical data

• Utilization Management-related accountabilities for Provider Assistance staff include:
  • Review of healthcare service requests for completeness of information
  • Collection and/or transfer of non-clinical data
  • Collection of defined clinical data using structured scripts or tools
  • Activities that do not require interpretation of clinical information or decisions regarding utilization of any clinical criteria for handling of a request for healthcare services or treatment
• Travel may be required for employees in regional offices

• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.