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Position Description

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

Position:  Product Specialist
Reports To: 
Division:  West Regn - Fort Smith (0069)
Company:  ABCBS
Location:  Fort Smith
Job Code:  100206
Min Salary:   38400
Date Posted:  6/19/2014

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Position Specific Requirements: This position requires licensure within three months after hire date.

Job Summary
As the primary contact for our customers, the Product Specialist 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 Product Specialist must embody the service vision, objectives, and values of the organization.

This position is accountable for selling and servicing all individual products for Arkansas Blue Cross and Blue Shield. The incumbent has the responsibility for assisting the prospects and customers in addressing plan questions and enrollment process.

This position requires highly motivated and dedicated individuals 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, the Product Specialist must demonstrate a thorough knowledge of product information, group and individual contract benefits, coordination of benefits, provider contracting and membership criteria. This enables the Product Specialist 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. Additionally, the Product Specialist performs pro active customer initiatives by telephone and makes on site visits as needed.

The Product Specialist must create and maintain an atmosphere of trust and confidence in the administration of policies and procedures of the Enterprise.

Nature & Scope
In order to enable the company to meet the needs of its customers in an ever-changing and competitive marketplace, the Product Specialist is required to adapt to the constantly changing nature of beneficiary/provider needs.

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 products; as primary responsibilities are focused on individual customers. In addition, knowledge of Health Advantage, BlueCard, and BlueAdvantage Administrators membership and enrollment guidelines, claims processing, and adjustment functions and medical policy are a must.

The incumbent must learn to operate different systems and be versatile in answering customer and provide inquiries. The Product Specialist is expected to be knowledgeable in all products sold by Arkansas Blue Cross and Blue Shield, Health Advantage, and BlueAdvantage Administrators. The individual must also be knowledgeable of all correspondence, booklets, newsletters and directories published by or about all entities within the enterprise.

The Product Specialist 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 has the authority to document and recommend modifications or enhancements, and to generate special reviews for exceptions as permitted by the customer. The Product Specialist 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 Product Specialist must be knowledgeable on the new member application process and agent regulations for selling insurance products in Arkansas. The incumbent is expected to assist customers in plan design and submission of applications. The incumbent is required to sign the application as agent of record.

The incumbent acts as a liaison between all support functions and the member/policyholder. This includes researching problems, concerns or inquiries and providing appropriate responses with correct information. Appropriate information may include preparation of periodic reports/data, information and, summaries to be submitted to management with appropriate documentation.

The Product Specialist 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.

The incumbent receives direction and guidance from the Statewide Business Department and the Regional Operations Manager or Supervisor. The employee is also guided by corporate policy and applicable regulatory procedures.

The challenges of this position are centered on the need to stay in touch with the ever-changing regulatory environment. This changing environment challenges the incumbent to identify and notify the Operations Manager and Statewide Business department of system problems. Meeting the corporate challenge of selling individual products and customer service satisfaction along with maintenance of a fast-paced workload is also a challenge of this position.

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 sales, service, production and quality goals of the team.
4. Innovative thinking.
5. Effective verbal and written communication skills. Demonstrates proficiency in written
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.
10. Above average decision making skills.
11. Above average initiative.
12. Ability to make PowerPoint presentations as required.

Minimum Job Requirements

1. Must meet at least one of the following education requirements:

A. High school diploma or equivalent plus experience in healthcare industry, medical provider setting, health insurance, medical supplier, medical terminology, claims processing or medical coding.
B. Two (2) years of college (at least 48 credit hours) plus experience in healthcare industry, medical provider setting, health insurance, medical supplier, medical terminology, claims processing or medical coding.
C. Bachelor's degree from an accredited college or university plus experience in healthcare industry, medical provider setting, health insurance, medical supplier, medical terminology, claims processing or medical coding.

2. State of Arkansas Life and Health License is required. If license is not previously held, must successfully pass exam within three months after assuming the position.

3. Two years personal computer experience utilizing Microsoft products.

4. Demonstrated ability to mentor team members

5. Proven ability to consistently work effectively with people in a professional and courteous manner

6. Must successfully complete the Customer Service Assessment

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.

• Ability to listen, comprehend what is said, be friendly and courteous.
• Prepare for and attend senior product meetings as required.
• Screening senior product applications received in the Region and determining next action necessary for
• Plan and organize activity to support marketing in the region regarding the Senior products.
• Communicate in a clear and concise manner, both orally and in writing with above average grammar and
vocabulary skills.
• Conduct him/herself in a positive professional manner at all times with customers and team members.
• Handle confrontational situations with empathy but also in such a manner as to reach fact based objective
conclusions and resolve.
• Handle confidential information with integrity and professionalism within HIPAA Guidelines.
• Gain conclusive agreement through negotiation
• Interact with all levels of internal staff, customers, and providers.
• Take initiative to perform job functions with minimal supervision
• Set personal goals to achieve divisional expectations.
• Identify areas for process improvement.
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