CareFirst Blue Cross/Blue Shield
Customer Service Representative I
UMBCworks ID#: 9233052 (access via the Jobs & Internships tab in myUMBC)
This position uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments
Examines adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, provider, medical policy, contracts and policy procedures. Researches, investigates and initiates resolution of pends by the processing system. Calculates and verifies deductibles, maximums, co-payments and coinsurance for resolving inquiries, facilitating adjustments, initiating extra contractual and reporting of any systems processing errors, overpayments and underpayments. Develops and applies the ability to analyze customer contracts and needs involving current product mix, risk assessment, and revenue impact. Develops service techniques and technical competence for the purpose of maximizing customer retention, satisfaction, and potential financial savings.
Effectively utilizes NASCO and/or CARE and/or FLEXX systems, products, contract and medical policy knowledge and processing techniques to resolve client inquiries. Demonstrates the flexibility to process and service various types of products within each line of business according to the established quality, productivity and performance metrics. Learns and retains the ability to access information ad effectively administer services using the company's automated systems.
Learns information required to effectively provide service to clients as it relates to inquires concerning pre-existing condition, knowledge of policies and riders, identification of other insurance ad coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions. Appropriately documents all client interactions according to established departmental procedures.
CareFirst offers an extremely competitive benefits package, including m/d/v, 401(k) with match, paid vacation and holidays just to name a few.