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Position Description

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

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Position:  Customer Svc Rep Late - 9
Reports To: 
Division:  BANA Customer Service II (2114)
Company:  ABCBS
Location:  Label
Job Code:  55816L
Min Salary:   30600
Date:  9/21/2012

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Position Specific Requirements: Work hours of this position are 1:00 p.m. to 10 p.m


Job Summary
As the primary contact for our customers, the Customer Service Representative (CSR) is one of the most important positions to our Enterprise. Our ability to provide outstanding service to our members continues to be a top goal for every associate at the Enterprise. 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 that our Enterprise expects, Customer Service Representatives must demonstrate a thorough knowledge of claims information, group and individual contract benefits, coordination of benefits, provider contracting and membership criteria. This enables our Customer Service Reps to provide accurate and courteous responses to members, policyholders, providers and employer representatives regarding all types of inquiries received via telephone, written or faxed, and in-person customers.

This position may assist the marketing staff with open enrollment and renewal negotiations. Additionally, the Customer Service Representative performs pro active customer initiatives by telephone and makes on site visits to assigned groups as needed.

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.

This position requires the representative to work a shift of 1:00 p.m. to 10 p.m.

SERVICE VISION

The right service for every customer every time.

SERVICE OBJECTIVES

We strive to make every service experience effective, efficient, customer-centered, timely, and complete.

SERVICE VALUES

• Put the customer first in everything that we do.
• Be a customer advocate to help customers quickly resolve any issues.
• Provide information that is easy to access and understand.
• Create a professional environment where we treat our customers and each other with respect, empathy, and courtesy.
• Develop knowledgeable Customer Service Representatives who speak confidently and provider correct and complete information for our customers.


Nature & Scope
The incumbent is part of a team responsible for maintaining good relations 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, Health Advantage or BlueAdvantage Administrators membership and enrollment guidelines, claims processing, and 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, Health Advantage or BlueAdvantage Administrators. The person must also be knowledgeable of all correspondence, booklets, newsletters and directories published by or about all entities within the enterprise.
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, Health Advantage or BlueAdvantage Administrators. The person must also be knowledgeable of all correspondence, booklets, newsletters and directories published by or about all entities within the enterprise.

The Customer Service Representative has the authority to make decisions as related to inquiries received from members and health care providers; to implement measures necessary to resolve problems and to communicate a response 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 with training of new staff as well as providing continuous coaching concerning any job duty of the CSR or system used by the CSR for internal staff concerning 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 responses with correct information. Appropriate information may include preparation of periodic reports/data, information, summaries and submits to management with appropriate documentation.

The Customer Service Representative is expected to deal tactfully with interdepartmental communications and is 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.

Skills, Knowledge, and Abilities

1. Ability to multi-task, organize, and prioritize.
2. Ability to work in a structured environment.
3. Ability to work independently and contribute to the achievement of service, production and quality goals of the team.
4. Innovative thinking.
5. Effective verbal and written communication skills.
6. Analytical skills.
7. Dress and present self in a professional manner.
8. Ability to remain calm while engaged in a stressful conversation or situation.
9. Ability to answer written correspondence.

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. College (at least 48 credit hours) plus experience in a specialized customer service environment.
C. Bachelor's degree from an accredited college or university.
2. Keyboarding skills.
3. Experience in healthcare, medical provider, insurance, medical supplier, medical terminology, claims processing, and/or medical coding is preferred.
4. Above average communication skills
5. Microsoft Outlook experience

Must pass CSR Assessment testing:

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

CSR Part 2: Contact Center Virtual Scenario

Upgrade Requirements - Grade 10

1. Representative must not have been placed on written warning in the previous 12 months.
2. Representative consistently takes appropriate percentage of ACD calls based on number of staff per day and log expected calls appropriately.
3. Representative fulfills requirements of new member call and group contacts where required.
4. Representative must have completed Service Excellence and applied principles and skills in daily contact with internal and external customers.
5. Individual must be a self starter, actively influence events to achieve goals, and take action beyond the minimum required for the position.
6. Representative must have completed and passed the Medical Terminology Course.
7. Representative has demonstrated the ability to work in a team environment.
8. Representative has demonstrated necessary technical/professional knowledge to make sound decisions, render judgment, take action, and perform the job without constant supervision.
9. Representative has demonstrated the ability to multi-task, organize, and prioritize.
10.Representative must have completed claims, eligibility and adjustment training and be able to assist with utilization review where required.
11. If required, individual must be able to travel with occasional over-night stays.
12.Representative must have completed the following in-house courses/training and applied principles and skills daily with both internal and external customers: Business Writing, Grammar, Service Excellence, and other courses as deemed necessary by the supervisor.
13.Representative's supervisor must have received no Consistent and substantiated negative feedback from customers within the previous 6-months.
14. Must currently be meeting all divisional performance standards and requirements for current grade.

Complete the following Blue and You University Courses:

  • Customer Service Over the Phone
  • Customers, Confrontation, and Conflict

Upgrade Requirements-Grade 11

1) An employee will be moved to Grade 11 when the following criteria has been met consistently for six months as determined by the supervisor with manager approval.
2) Demonstrates leadership skills:
a. Serves as mentor for other representatives.
b. Above average decision making skills
c. Above average initiative
3) Must accept one of the following responsibilities:
a. Training
b. Coach/Technical Resource
4) Ability to make PowerPoint presentations as required.
5) Demonstrates proficiency in written correspondence.
6) Demonstrates concierge service on a daily basis.
7) Proficient knowledge of appropriate systems.
8) 90% or above in inquiry accuracy.
9) Must currently be meeting all divisional performance standards and requirements for current grade.

Complete the following Blue and You University Courses:

  • Advancing Service Expertise
  • Communication Business Etiquette

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.

PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1. Ability to listen, comprehend what is said, be friendly and courteous.
2. Communicate in a clear and concise manner, both orally and in writing with above average grammar and vocabulary skills.
3. Conduct him/herself in a positive professional manner at all times with customers and team members.
4. Handle confrontational situations with empathy but also in such a manner as to reach fact based objective conclusions and resolve.
5. Handle confidential information with integrity and professionalism within HIPAA Guidelines.
6. Gain conclusive agreement through negotiation.
7. Interact with all levels of internal staff, customers, and providers.
8. Take initiative to perform job functions with minimal supervision.
9. Set personal goals to achieve divisional expectations.
10. Identify areas for process improvement
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