Regence Customer Service Professional - Fulltime Remote in WA, ID, OR and UT

Company: Cambia Health Solutions, Inc
Location: Tacoma
Posted on: March 16, 2023

Job Description:

Regence Customer Service Professional IRemote within ID, OR, WA, or UT. Candidates outside of these states will not be considered.Starting pay range $16.20 - $20.10 DOE and Location. HR will reach out and provide specific information. We will be conducting verification of employment on your current and past employment if selected to hire. Please make sure you are applying with the most updated resume with correct dates of employment.Primary Job Purpose:The Customer Service Professional I provides information, education and assistance to members, providers, other insurance companies, attorneys, agents/brokers or other customer representatives on recorded phone lines regarding benefits, claims and eligibility. They also provide services to all callers.The Customer Service Professional I is likely to be the primary contact between the corporation and members and providers. The manner in which a member or provider is treated during that contact is essential to retaining our customers and to the overall success of the corporation.Normally to be proficient in the competencies listed below:Customer Service Professional I would have a high school diploma or equivalent and 1 year customer service call center experience or 1 year customer service experience such as insurance, retail, banking, restaurant, hospital medical office or other experience with extensive customer service contact or equivalent combination or education and experience.Responsibilities:

• Complete training period and meet dependability, timeliness, accuracy, quantity, and quality standards as established by department. Study, review and learn information, procedures and techniques for responding to various inquiries.
• Connect with subscribers, providers, healthcare providers, agents/brokers, attorneys, group administrators, other member representatives, internal staff and the general public with inquiries regarding benefits, claim payments and denials, eligibility, decisions, and other information through a variety of media - oral, written and on-line communications. Respond to multiple inquiries on all designated lines of business.
• Quickly and accurately assess provider and member inquiries and requirements by establishing a rapport to understand service needs. Identify errors promptly and determine corrective steps may be taken to resolve errors.
• Apply benefits according to appropriate contract. Determine benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.
• Make appropriate corrections of denied, process-in-error or re-classified claims.
• Explain benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to callers to ensure that benefits, policies and procedures are understood.
• Educate members and providers on confusing terminology and policies such as eligible medical expenses, hold harmless, medical necessity, contract exclusions and limitations, and managed care products.
• Maintain confidentiality and sensitivity in all aspects of internal and external contacts.
• Handle high volume of calls daily, prioritize follow-through and document/log inquiries and actions taken during phone calls. May generate written correspondence and process document requests.
• May provide face-to-face member and provider service and education in a lobby setting or walk-up counter using a PC. Assist individual, Medicare and other applicants in completing their applications and answering any questions they may have. When required, may maintain a cash drawer and ensure that it balances daily.
• Maintain files/records of constantly evolving information regarding benefits/internal processes including company-wide internal policies and benefit updates for new or existing business. Work is subject to audit/checks and requires considerable accuracy, attention to detail and follow-through.
• Align with NMIS/MTM and Consortium standards as they relate to the employee's responsibility to meet BlueCross BlueShield Association (BCBSA) standards and company goals.
• Assist in identifying issues and trends to improve overall customer service.
• For HMO related work: Enter, correct and adjust referrals according to established policies and procedures. Explain referral rules, processes to providers and internal customers.Minimum Requirements:
  • Keyboarding skills of 30 wpm with 95% accuracy.
  • Proficient PC skills and prior experience in a PC environment.
  • Demonstrated knowledge of medical terminology and coding preferred.
  • Ability to apply mathematical concepts and calculations.
  • Ability to communicate effectively orally and in writing with understanding and accurate use of punctuation, spelling, grammar and proof-reading skills.
  • Demonstrated ability of strong customer-service skills, including courteous telephone etiquette.
  • Ability to make decisions and exercise good judgment in a complex and rapidly changing environment.
  • Ability to adapt to a fast-paced environment and learn, retain, and interpret new or evolving information, procedures, and policies and communicate them effectively.
  • Ability to work under stress and pressure and respond to inquiries with tact, diplomacy and patience.
  • Ability to work as part of a team.
  • Ability to exercise discretion on sensitive and confidential matters.
  • Demonstrate initiative in researching and resolving benefit, and eligibility issues.
  • This is a full-time and permanent remote positionWork Environment:
    • May be required to work overtime.
    • May be required to work outside normal hours.

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