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Position Description

Arkansas Blue Cross and Blue Shield - NON-EXEMPT POSITION DESCRIPTION

Position:  Customer Service Rep - 9
Reports To: 
Division:  Customer Service (0014)
Company:  ABCBS
Location:  Label
Job Code:  55815L
Min Salary:   31800
Date Posted:  2/3/2014

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Position Specific Requirements: None

Job Summary
As the primary contact for our customers and the front line of Arkansas Blue Cross & Blue Shield, the Customer Service Representative (CSR) is one of the most important positions in the Enterprise. Our ability to provide outstanding service to members continues to be a top goal for every employee. For this reason, the Customer Service Representative must embody the service vision, objectives, and values of the organization.

This position requires highly motivated and dedicated personnel accountable for ensuring final disposition of each inquiry in a timely manner while systematically documenting detailed customer information relevant to each customer contact.

To provide the excellence in Customer Service the Enterprise expects, Customer Service Representatives must demonstrate a thorough knowledge of claims information, group and individual contract benefits, coordination of benefits, regulations and guidelines, provider contracting and membership criteria. This knowledge enables CSRs to provide accurate and courteous responses to members, policyholders, providers, and employer representatives regarding all types of inquiries received via telephone, written, electronically transmitted, faxed, and/or in-person.

The incumbent may also be called upon to fully research, analyze, and resolve special projects and other problem inquiries as directed by the Supervisor and/or Manager of Customer Service, the Vice President of Internal Operations and the other operational areas of the division and of the enterprise. Tasks within the division include, but are not limited to the accurate and timely processing of all types of inquiries entered on the CSW system while tasks within the enterprise include, but are not limited to Information Desk and Walk-In Customer Service operations.

The Customer Service Representative also must create and maintain an atmosphere of trust and confidence in the administration of policies and procedures of the Enterprise.

Nature & Scope
The incumbent is part of a team responsible for maintaining positive relationships with all policyholders, providers, vendors, and plan personnel in a friendly and courteous manner. The incumbent must have extensive knowledge of the Arkansas Blue Cross and Blue Shield membership and enrollment guidelines, claims processing, adjustment functions and medical policy.

The incumbent must learn to operate different systems and be versatile in answering customer and provider inquiries. The Customer Service Representative is expected to be knowledgeable in all products sold by Arkansas Blue Cross and Blue Shield. This person must also be knowledgeable of all correspondence, booklets, newsletters, and directories published by or about all entities within the enterprise.

The CSR has the authority to make decisions as related to inquiries received from members and health care providers as well as implement measures necessary to resolve problems and to communicate responses orally or in written form to the inquirer. This position also has the authority to document and recommend modifications or enhancements, and to generate special reviews for exceptions as permitted by the customer. The Customer Service Representative assists new staff concerning any CSR job duties or system used regarding benefits, benefit interpretation, and eligibility.

The incumbent acts as a liaison between all support functions and the member/policyholder. This includes researching the problem, concern, or inquiry and providing appropriate and timely responses with correct information. Appropriate information may include preparation of periodic reports/data, information, and summaries submitted to management as need/requested with appropriate documentation, and other insurance information for the OPL system.

As the face of Arkansas Blue Cross & Blue Shield, the Customer Service Representative is expected to tactfully deal with interdepartmental communications while being cooperative and open minded in working with others. They must be able to act with a sense of urgency when needed and have exceptional problem solving and analytical skills while being detail oriented. The desire to go the extra mile and provide exceptional customer service is a must.

This position seeks guidance from the Blue Cross Customer Service leadership team, as well as peers and other internal staff within Arkansas Blue Cross Blue Shield.  The incumbent will also work with the Internal Operations training staff and internal QA team to develop and coordinate improvement processes and training opportunities for staff.

The greatest challenge of this position is to ensure that inquiries are answered accurately, professionally and timely.  At times, some of our policyholders are irate and unwilling to accept decision made by the Plan. Because of this, the incumbent must be careful to maintain a positive image of the company to the public.  A great deal of understanding and expertise must also be exhibited when personally handling sensitive situations with the callers.  As the growth and complexity of the Plan increase, the position becomes more involved.  His/her knowledge of all phases of the corporation must continue to expand in order to keep current with the changes.  

This position will interface regularly with Blue Cross Customer Service management, supervisors, trainers, analysts, and operations staff.  The incumbent would also interface with various other Arkansas Blue Cross Blue Shield internal staff.

This position has the authority to make any number of decisions within the limits of the Benefit Policy manual, enrollment regulations and other company guidelines.  When unusual situations arise, he/she has the authority to request exceptions or review by the appropriate authority.

The incumbent must possess superior communication skills while developing and maintaining diplomatic rapport with all internal and external customers.  Necessary skills require effective writing of memorandums, emails, complete and thorough documentation of exceptions and inquiries.

Knowledge, Skills and Abilities

1. Ability to work through and resolve conflict.
2. Ability to multi-task, organize and prioritize workload
3. Ability to work in a structured environment
4. Ability to work independently and contribute to the achievement of service, production, and quality goals of the team.
5. Superior verbal and written communication skills
6. Above average interpersonal skills
7. Above average analytical skills and develop an appropriate solution
8. Ability to act as resource for information and assistance by management and supervisory staff.
9. Ability to professionally represent Arkansas Blue Cross Blue Shield at meetings and other appropriate functions.
10. Dress and present self in a professional manner.
11. Ability to organize workflow to establish goals and plan for maximum efficiency to achieve those goals.
12. Ability to use PC/Mainframe/Microsoft Office/Support Systems.
13. Ability to remain calm while engaged in a stressful conversation or situation.

Minimum Job Requirements

1. Must meet at least one of the following:
A. High school diploma or equivalent with experience in a specialized customer service environment.
B. Some college plus one experience in a specialized customer service environment.
C. Bachelor's degree from an accredited college or university.
2. Must successfully complete contact center scenario and Windows based navigation assessments.
3. Keyboarding skills.
4. Experience in healthcare, medical provider, insurance, medical supplier, medical terminology, claims processing, and/or medical coding is preferred.
5. Above average communication skills
6. Microsoft Outlook experience

Assessment/Testing needed:

CSR Part 1: Call Center, Following Instructions, & Contact Center Retention

CSR Part 2: Contact Center Virtual Scenario

Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

1. Ability to listen and comprehend what is being said
2. Ensure timely, accurate and courteous response to inquiries.
3. Communicate in a clear and concise manner, both orally and in writing with above average grammar and vocabulary skills.
4. Conduct him/herself in a positive professional and courteous manner at all times with customers and team members.
5. Handle confrontational situations with empathy but also in such a manner reaching fact based and objective conclusions and resolve.
6. Handle confidential information with integrity and professionalism within HIPAA Guidelines.
7. Gain conclusive agreement through negotiation.
8. Provide recommendations to management to implement changes improving service and increase customer satisfaction.
9. Interact with all levels of internal staff, customers, and providers.
10. Take initiative to perform job functions with minimal supervision.
11. Set personal goals to achieve divisional expectations
12. Stay informed of all changes in benefits, regulations, and guidelines.
13. Maintain performance levels in order to meet national and divisional performance standards and Plan objectives.
14. Create a solid working relationship with all groups by working directly with contacts as needed to resolve issues.
15. Develop and maintain effective working relationships with other departments/divisions within the enterprise
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