Position Description:
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
Coordinate the receipt, classification, processing, documentation, and acknowledgment of correspondence and general inquiries received in Operations. Provides technical, statistical, and administrative support to the supervisor of the assigned unit. Serves as an alternate point of contact for one or more of the following: Client services support analysts, account executives, plan personnel, par plans, providers, vendors, group administrators, producers, and the public in areas about the triage process and workflow. Provides general support to all internal departments and external entities that are involved in the triage process. Monitors and coordinates the overall general case activity to ensure correct and timely completion.
Responsibilities and Qualifications:
- 15% - Provides support to unit personnel, company personnel, and outside entities concerning distribution and workflow of cases and general inquiries.
- 15% - When relevant, ensures BCBSA Member Touchpoint Measures (MTM), HIPAA and CMS quality and timeliness standards are met.
- 10% - Compiles and reports to management statistics regarding the information logged on Sales Force, OnBase, Work Desk, FACETS, IVR, Imaging and other on-line systems. Generate reports, as necessary.
- 10% - Serves as a point of contact for unit personnel for requesting and receiving information concerning the receipt, classification, and acknowledgment of general inquiries. Recognizes critical, urgent, priority requests, and acts with urgency.
- 15% - Monitors unit workflow by assessing and assigning work responsibilities.
- 15% - Assists in the research, documentation, accurate and prompt responses to expedited and standard cases. As well as other complex priority inquiries received from group administrators, producers, sales, providers, attorneys, individual subscribers, Par Plan personnel, internal personnel, and other outside entities working on the beneficiary's behalf.
- 5% - Participates in special projects as assigned. Collects data and drafts reports concerning issues affecting department functions and operations specific to the triaging process.
- 5% - Compiles statistical information that is necessary to effectively monitor unit and departmental goals and objectives.
- 5% - Assesses and reports to management individual employee coaching needs. Additionally, the incumbent may conduct peer reviews, document findings as assigned, supply audit support, desk mentoring for newly hired staff, staff support undergoing cross-training, and provide functional training for peers, as required by workload.
- 5% - Performs ongoing review of case inventory and monitors processing to ensure the timeliness standards are met. Helps in the design and development of department quality evaluation processes. Serves as back up for other department coordinators in their absence.
Skills:
- Demonstrate ability to coordinate, prioritize and organize tasks and schedules to meet priorities and goals set forth by department management with minimal supervision.
- Demonstrates ability to work independently, be flexible, and react appropriately to changing job assignments and work environments.
- Demonstrates analytical, organizational, and critical thinking skills to identify, analyze as well as identify and analyze trends and discrepancies accurately and efficiently.
- Familiar with, or ability to, use a PC and associated software; Microsoft Word, Excel, phone equipment, calculator, fax, copier, and other department required hardware etc.
- Demonstrated competency in Windows (Outlook, Word, Internet Explorer, Excel, and PowerPoint)
- Above average reading, writing, and arithmetic skills needed (reading/math comprehension)
Knowledge:
- Knowledge of benefit programs and products administered and/or supported by Capital BlueCross. Includes Commercial Medical, Medicare Advantage, Medicare Part D and Medicare Supplemental Programs, Dental, Vision, Prescription Drug, Care Management.
- Knowledge of the Pharmacy Benefit Manager (PBM) and Facets health plan administration processing systems as well as online files for claims, enrollment, billing, and benefits. Knowledge of benefits administration policies, customer billing processes, claims processing and general procedures.
- Knowledge of ERISA, Act 68, and BCBSA MTM, PPACA, HIPAA quality and timeliness guidelines and standards to ensure these standards are consistently satisfied or exceeded.
- Knowledge of policies and procedures pertaining to Capital BlueCross
- Knowledge of multiple online operations systems and coding structures of files to interpret data used in responding to inquiries and cases.
Experience:
- 3 years customer service experience/training and exceeding job performance standards of the Senior Customer Service Representative or demonstrated related experience.
Education and Certifications:
- High School degree or equivalent.
- Preferred: Bachelor’s degree in business administration, health care administration, or a related field.
Work Environment:
Sedentary work involving significant periods of sitting, talking, hearing, keying, and performing repetitive motions. The work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor. The working environment includes typical office conditions.
Physical Demands:
While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work 37.5 hours per week. The employee must occasionally lift and/or move up to 5 pounds.
About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
