Member & Provider Services Representative - CUS0009E
DESCRIPTION/RESPONSIBILITIES:
Responsible for properly handling all telephone, written and walk-in inquiries. Investigate, research, process, resolve and respond to member, provider and agent inquiries. Update membership information following customer service guidelines. Educate new and existing members and providers concerning BCN Advantage policies/procedures and benefits through telephone inquiries.
* Investigate, process, resolve and respond to member, provider, or agent inquiries received via telephone, written correspondence, or in person regarding benefits, eligibility, material forms, ID cards, PCP changes, claims, complex inquiries and quality of care issues.
* Initiates status calls to the inquirer when delays occur in responding to an inquiry as required. Reroute misdirected inquiries.
* Educate new and existing members, providers, or agents concerning BCN Advantage policies, procedures and benefits through 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.
* Maintain positive relationships and interactions with employees, enrolled members, potential members, providers, employer groups, and vendors
* Special projects and other duties as assigned.
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.