CAPS - BC Home - Hybrid 2

Purpose of the job

This is a highly specialized customer service position with an emphasis on excellence, privacy, compliance and versatility within the health insurance industry. The position will identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.

Qualifications

• Required Work Experience: 1 years of experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field

• Required Education: High-School Diploma or GED in general field of study

• Required Licenses: N/A

• Required Certifications: N/A

• Preferred Work Experience: 2 year(s) of experience in claim processing, customer service, call center, health insurance, medical office, or other healthcare-related field

• Preferred Education: Associate's Degree in general field of study

• Preferred Licenses: A valid Arizona driver license with an acceptable driving record if travel is required (e.g. regional employees)

• Preferred Certifications: N/A

Essential Job Functions and Responsibilities

• Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.

• Answer a diverse and high volume of health insurance related customer calls and correspondence daily.

• Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.

• Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.

• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.

• Document and record facts in regard to inquiries and correspondence by updating BCBSAZ files and system.

• Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.

• Utilization Management-related accountabilities for FEP staff include:

  • Review of healthcare service requests for completeness of information
  • Collection and/or transfer of non-clinical data

• Utilization Management-related accountabilities for Provider Assistance staff include:

  • Review of healthcare service requests for completeness of information
  • Collection and/or transfer of non-clinical data
  • Collection of defined clinical data using structured scripts or tools

• Activities that do not require interpretation of clinical information or decisions regarding utilization of any clinical criteria for handling of a request for healthcare services or treatment.

• Travel may be required for employees in regional offices.

• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

• Perform all other duties as assigned.

Competencies

• Required Job Skills: Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones; Type 30 to 35 words per minute with 5% error rate or less; Intermediate PC proficiency; Advanced bilingual (Spanish/English) skill in verbal communication - Mi Consejero Azul only; Intermediate bilingual (Spanish/English) skill in written communication - Mi Consejero Azul only

• Required Professional Competencies: Maintain confidentiality and privacy; Practice interpersonal and active listening to achieve high customer satisfaction; Compose and dictate a variety of business correspondence; Interpret and translate policies, procedures, programs and guidelines; Capable of investigative and analytical research; Navigate, gather, input and maintain data records in multiple system applications; Follow and accept instruction and direction; Establish and maintain working relationships in a collaborative team environment

• Required Leadership Experience and Competencies: N/A

• Preferred Job Skills: Type >35 words per minute with 5% error rate or less; Intermediate knowledge of insurance claim coding; Intermediate understanding of dental and medical terminology; Intermediate comprehension of anatomy and medical practices

• Preferred Professional Competencies: Knowledge of a wide range of subjects pertaining to the organization's service and operations

• Preferred Leadership Experience and Competencies: N/A