Member Services Rep I (MD Medicaid and Medicare)

Owings Mills, MD
Jul 28, 2021
Jul 30, 2021
Accountant, IT
Full Time
Resp & Qualifications Position Summary Fully trained Member Services Representative to respond to member/provider inquires, whether of a substantive nature, a procedural nature, or both. The position provides customer service to all inbound calls as well as making outbound/outreach calls when necessary. All calls routed through an Automatic Call Distribution (ACD) system, from members and/or providers on a variety of topics to educate them on benefit issues, claims inquiries and collect feedback regarding various campaign initiatives. Essential Duties and Responsibilities * Complies with 100% of HIPAA/PHI regulations in all interactions with internal (representative from other departments) as well as external (members/providers) customers * Handles /or exceeds goal of average of a minimum 55 calls a day, while meeting the service standards (after the 90-day probationary period) * Maintain and average talk time of no more than 9-10 minutes * Meet or exceed a minimum QA score of 90% * Consistent documentation and selection of the right codes for all member/provider calls and concerns in the appropriate systems * Resolve and close all assigned Open issues in accordance with department turn-around times * Meet department overall performance goals * Serve as a member advocate * Follows up on pending unresolved issues * Provides expertise and customer service support to internal and external customers * Documents complaints and grievances in the appropriate systems and forwards to the appropriate entities timely * Meets and maintains tardiness and attendance standards set by department policy * Performs other duties and activities as deemed necessary * Successful completion of all CS training sessions * 100 adherence of departmental and company's code of conduct and professionalism * Attends to the members/providers inbound calls to assist with any appropriate information about benefits, provider and customer service issues * Handle all calls courteously, politely and professionally * Favorable HR Issue/CM outreach case Audit results (measurement TBD) Education and Qualifications * Minimum 1-2 years Customer Service or ACD Call Center Experience preferred in a health insurance, medical or equivalent field. * Minimum of 1 year of College experience preferred or equivalent directly related experience. * High school diploma required. * Strong verbal and written communication. Knowledge, Skills, Abilities * Excellent interpersonal skills. * Professional organizational, oral and written communication skills. * Ability to listen, document and track problems within the appropriate systems, simultaneously while on calls. * Ability to respond in difficult situations on the telephone calls. Maintain flexibility and a "can do" attitude supporting department goals and objectives. * Able to commit to overtime as needed and/or shift changes. * Ability to type a minimum of 35 wpm. * Successfully complete in-house training program (90% or better on final test). Computer Skills * Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word Department Department: MD Medicaid -MEMBER SERVICES Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Hire Range Disclaimer Actual salary will be based on relevant job experience and work history. Where To Apply Please visit our website to apply: Closing Date Please apply before: 6/8/21 Federal Disc/Physical Demand 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. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the US without Sponsorship#06022021

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