Regence Customer Service Professional I Washington

Primary Job PurposeOpen to all applicants within: Oregon, Washington, Idaho and UtahThe Customer Service Professional I role is a full-time remote positionPosition starts: Monday, May 3rdPosition closes to new applicants: Wednesday, March 24thDue to growth of our company and department, we are looking to expand our team. Bring your excellent customer service skills to the FEP Customer Service I role! As an FEP Customer Service Professional I, you will provide information, education and assistance to members, providers, other health-care professionals, or other provider representatives on recorded phone lines regarding benefits, claims and eligibility. In addition, you will:* Be the primary contact between the corporation and the consumer.* Quickly and accurately assess all inquiries and requirements.* Identify errors promptly and determine what corrective steps may be taken to resolve errors.* Determine benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.* Explain benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to providers to ensure that benefits, policies and procedures are understood.General Functions and Outcomes* Successfully 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 a variety of inquiries.* Communicate with a variety of 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 rapport in order to understand his/her service needs. Identify errors promptly and determine what 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.* Review and recommend appropriate corrections of denied or erroneously processed claims.* Explain benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to members and providers 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.* Manage high volume of calls on a daily basis, prioritize follow-through and document member and provider inquiries and actions on tracking system and/or by completing logs. May generate written correspondence and process document requests.* Maintain files/records of constantly changing 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.* Comply with the standards of the Federal Employee Program as they relate to the employee’s responsibility to meet BlueCross BlueShield Association (BCBSA) standards and corporate goals.* Assist in identifying issues and trends to improve ovTo view the full job description, click here