Company :Highmark Inc.
Job Description :
1. Responds to and resolves inquires from subscribers, members, groups, other plans and other departments: •Communicates and interacts with internal and external customers in a clear, unambiguous, concise, professional and empathetic fashion. •Handles all inquiries and services incoming and outbound calls and correspondence. •Considers all aspects or elements in a logical manner; considers contractual provisions and options to resolve inquiry; communicates with internal and external customers. •Utilizes and interprets appropriate reference materials and other necessary resources in responding to inquiries. •Communicates with internal and external customers via phone, personal contact (lobby walk-ins), email, online chat or in writing; utilizes Letter Reference Guide (LRG) templates as necessary. •Takes ownership of problems and establishes relationships with customers meeting all corporate guidelines. •Demonstrates an ability to communicate the contract benefits and requirements to the customer; communicates pros and cons of various plan benefit differences. •Coordinates with Marketing and Enrollment staff and other internal and external entities.
E2. Pursues, researches, tracks and follows up on information regarding claim benefits, eligibility and all other aspects of business: •Acts as frontline contact for company, identifies potential problems and inconsistencies and corrects to prevent ongoing or future problems; recommends and forwards to Sr Service Representative and/or Management for review. •Researches, prepares responses and provides supporting documentation. •Identifies potential fraud cases and forwards to Special Investigations Unit.
E3. Adjusts claims: •Performs online transactions and/or adjustments. •Determines claim disposition by reviewing correspondence and claim inquiry history; follows desk levels, standard operating procedures.
E4. Performs all job duties efficiently, accurately and at an acceptable level of performance.
N5. Performs related clerical duties: •Files, faxes, copies documents.
E6. Maintains confidentiality and adheres to HIPAA regulations.
E7. Delivers customer service in a professional, polite and efficient manner.
N8. Performs other duties of a similar nature that are not inconsistent with this position or pay grade.
One year customer service, contact center, or healthcare related experience as demonstrated by proficiency in one or more of the following areas: claims processing, adjusting or membership is required. Two (2) years Customer Service related experience in a high volume call/contact center is preferred.
1. Must meet qualifications to perform the job including satisfactory completion of all training and testing
2. Customer Service Representative tests - passing score
3. Ability to multitask in fast paced environment
4. Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
5. Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner
6. Ability to effectively communicate in both written and verbal communication with internal and external contacts, in a professional manner
7. Working knowledge of personal computer and application software such as Microsoft Office
8. Ability to utilize basic office equipment including PC, scanner, telephone, copier, printer, fax, calculator
9. Computer Software typically used: Content Manager, Facets/Streamline, PEGA, OnDemand
Identifies problems and inconsistencies; recognizes major issues, identifies key facts; seeks information.
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Other Job Specifications:
External Contacts: Customers, Providers, Groups, other insurance plans
Working Conditions/Physical Demands:
* Must be able to work in an office environment
* Physical Effort: Minimum; typical of most office work. Mostly sedentary work.
* Weight: lift/carry/push/pull under 10 lbs.
* Prolonged Sitting
* Repetitive Motion
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Vision Req: Close vision (clear vision at 20 inches or less)
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )
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