CareFirst–Customer Service Representative III

 

Job Title: CUSTOMER SERVICE REPRESENTATIVE III

Location: WASHINGTON DC – UNION                               Career Band:  BAND II

Job ID #: 8223

This position may be filled as CSR II or III depending on candidates experience and business needs

PURPOSE:  Level III Representative must demonstrate proficiency and consistently “meet” or “exceed” performance expectations in all of the requirements for the Level II Representatives.  A primary function for Level III is to demonstrate the ability to perform at multiple service functions at the highest level with the highest degree of proficiency, as well as the ability to demonstrate a higher level of competence at their cross functional ability.  Incumbent should perform in another area of service expertise to include claims processing of adjustments, claims adjudication; complex claims adjustments, processing of emails and written correspondence.  Additionally, the incumbent must be a product specific subject matter expert and should demonstrate proficiency in training, coaching and function as a subject matter expert and as a motivational resource for the Level I and Level II associates. The scope of this position is focused on more strategic and long term approaches to improving the overall performance and the development of both the associate staff and department.

PURPOSE:  Level III Representative must demonstrate proficiency and consistently “meet” or “exceed” performance expectations in all of the requirements for the Level II Representatives.  A primary function for Level III is to demonstrate the ability to perform at multiple service functions at the highest level with the highest degree of proficiency, as well as the ability to demonstrate a higher level of competence at their cross functional ability.  Incumbent should perform in another area of service expertise to include claims processing of adjustments, claims adjudication; complex claims adjustments, processing of emails and written correspondence.  Additionally, the incumbent must be a product specific subject matter expert and should demonstrate proficiency in training, coaching and function as a subject matter expert and as a motivational resource for the Level I and Level II associates. The scope of this position is focused on more strategic and long term approaches to improving the overall performance and the development of both the associate staff and department.

PRINCIPAL ACCOUNTABILITIES: Under the direction of either a Manager or a Supervisor, the incumbent’s essential duties and responsibilities include, but are not limited to, the following: ●Provides effective support in coaching, training and the motivation of Level I and Level II associates.  Assists and supports the department and team with maintaining cases, adjustments and correspondence inventories using proven best practices.  Development of clinics and workshops to assist associate staff with meeting the inventory metrics. ●Functions as a subject matter expert with increased visibility at meetings, conference calls and projects as a representative stakeholder in the outcome of corporate, departmental and divisional initiatives.

  • Demonstrates proven ability to perform all service functions at the highest level with the highest degree of proficiency, as well as the ability to achieve a higher level of competence at their cross functional ability to perform in another area of service expertise to include claims adjudication, complex claims adjustments, processing of email and written correspondence and handling of walk-in clients.
  • Use knowledge of products and the contractual provisions that govern administration to provide effective customer service and education, to interpret contractual language to client for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of service to a client within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments.  Appropriate documentation of all client interactions according to established departmental procedures.  QUALIFICATION REQUIREMENTS: Required: High School diploma or equivalent.  Position requires performance at “meets standards” or above for 5+ years of customer service and/or claims adjudication.  Healthcare and/or Insurance industry experience is a must. The incumbent must be cross trained between service and claims adjustment with the ability to handle varied and more complex issues. Abilities and Skills: Proficiency in use of FLEXX and/or CARE and/or NASCO automated systems, PC or CRT.  Excellent oral and written communication skills, time management and organizational management skills.  Strong analytical abilities, problem-solving skills and the ability to work independently in a fast paced work environment.  Demonstrated success in the training and development of associate staff and department through effective team skills, leadership skills, quality improvement, productivity, business flexibility and customer retention. Preferred: 2-4 years of college in Business or other related field.  Bilingual in Spanish, etc. is a bonus.

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Department:  Small/Medium SBU Broker Service – DC

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Actual salary will be based on relevant job experience and work history.

www.carefirst.com/careers

Please apply before: February 8, 2016

Must be eligible to work in the U.S. without Sponsorship

 

 

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