Evaluates, and resolves inquiries involving a variety of claim, benefit, membership, and/or billing inquiries. Must be able to pass the Customer Service selection process, in order to interview.
Conducts internal and external research to determine and request the data needed to handle inquiries from internal and external business partners.
Provides accurate and timely servicing responses via telephone, and/or written correspondence to our internal and external customers.
Follows department/corporate reporting policies and procedures requirements.
Organizes work to meet productivity and quality standards.
Reroutes misdirected inquiries.
Interacts with others inside and outside the organization to resolve the inquiry/claim related problems.
Resolves customer inquiries through clear and simple explanations of the applicable policy and/or procedure.
May assist less experienced Customer Service Representatives and handle unusual or urgent inquiries, including irate calls.
Perform other related duties as assigned.
"Qualifications"
High school graduate or GED equivalent is required.
Two (2) years of related work experience in areas such as public/customer service, sales representatives claims processing, membership/billing/enrollment; and one (1) year of customer service experience in positions such as teaching, social service work, bank teller, medical assistant/office assistant, retail.
Three (3) years of total related experience or in the absence of internal BCBSM experience, the following may apply: A total of three (3) years of related work experience in areas such as public/customer service, sales representative, claims processing, enrollment/membership, or billing processing. Eighteen (18) months as an Account Clerk IV in Group Billing/Direct Billed/Auto National Membership and Support Departments.
Demonstrated knowledge of policies, practices and procedures related to membership, billing, contract coverage or changes, rating and eligibility requirements, and/or claims processing.
Demonstrated ability to resolve inquiries related to benefits, claims processing, and/or membership/billing, with little or no assistance.
Demonstrated command of all oral, written, and interpersonal skills necessary for communications with subscribers, beneficiaries, accounts or providers, in a clear, concise and tactful manner.
Work experience requirements may be modified within the three (3) year total, to fit individual unit needs. Must be able to pass the Customer Service selection process.
Employees shall meet a twenty-four (24) month tenure requirement, excluding training.
Other related skills and/or abilities may be required to perform this job.
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.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
Please see job description for required skills.
