Horizon BlueCross BlueShield is seeking individuals who are committed to gaining a thorough understanding of Horizon's product base and who will demonstrate proficiency and consistently meet or exceed performance expectations.
KEY RESPONSIBILITIES AND ACCOUNTABILITIES
Use knowledge of products and the contractual provisions that govern administration to provide effective customer service and education Interpret contractual language to client for the purpose of providing benefit utilization and limitations Determine the need for managed care initiatives. Administer all types of service to a client through telephonic inquiries. Appropriate documentation of all client interactions according to established procedures. Demonstrate the ability to perform a service function at the highest level with a great degree of proficiency. Demonstrate best practices and learned skills in order to assist the team with improved quality, productivity and performance metrics. Learns information required to effectively administer service to clients as it relates to inquiries concerning pre-existing conditions, knowledge of policies and riders, identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions.
MAIN JOB REQUIREMENTS
Education and specific training
High school diploma or equivalent 2-4 years of college in Business or other related education. Healthcare and/or Insurance Industry experience is strongly preferred. .
2-5 years of prior customer service experience
Special certifications (if appropriate; identify if required to perform or just preferred)
Soft and specific skills
Use of automated systems. PC or CRT proficiency. Excellent oral and written communication skills. Time management and organizational management skills. Strong analytical abilities and problem-solving skills. Ability to work independently and as part of a team in a fast paced work environment through effective team skills. Quality improvement, productivity, business flexibility and customer retention. Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every customer, including customers who may be demanding or otherwise challenging.
NOTE: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.