Member & Provider Services Representative - CUS0008V
DESCRIPTION/RESPONSIBILITIES:
Responsible for properly handling all telephone, written and walk-in inquiries. Investigate, research, process, resolve and respond to member and provider inquiries and quality of care issues via telephone, written correspondence, or in person. Update membership information following customer service guidelines. Educate new and existing members, providers, and beneficiaries concerning BCN Advantage policies/procedures and benefits through verification/welcome calls and daily telephone inquiries. Assist with eligibility activities as needed. Assist in project work serving as subject matter expert and provide on the job training.
Investigate, process, resolve and respond to member, provider, or beneficiary inquiries received via telephone, written correspondence, or in person regarding benefits, eligibility, material forms, ID cards, PCP changes, complex inquiries and quality of care issues. Will 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 inquiries. Educate new and existing members, providers, or beneficiaries concerning BCN Advantage policies, procedures and benefits through welcome/outbound verification calls and daily telephone inquiries. Documents each contact through BCN’s customer tracking/imaging/workflow system. Documents pertinent facts regarding inquiries, and update appropriate files. Update membership information following BCN Advantage member services guidelines. 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. Assist with Eligibility services activities, including processing eligibility transactions. Assist with retention/recovery and outreach activity. Assist with the annual working aged audit as required by CMS. Assist in project work serving as subject matter expert and provide on the job training. Special projects and other duties as assigned. Maintain positive relationships and interactions with employees, enrolled members, potential members, providers, employer groups, vendors, CMS representatives, BCBS Auditors and BCN Corporate Compliance Department.
VEVRAA Federal Contractor
Request Priority Protected Veteran Referrals
EOE -Veteran /Disabled/Minority/AA/F/M/SO
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, protected veteran status or status as an individual with a disability.
