CareFirst–Customer Service Representative II

Job Title:  Rep, Customer Service II

Location: Portals/DC

Career Band:  II

Job ID #: 8564

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:

1. 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.

2. Demonstrates the ability to perform at least one service function at the highest level with a greater degree of proficiency, as well as the ability to demonstrate competence at their cross functional ability to perform in another area of service expertise, such as claims adjudication, complex claims adjustments, processing of emails and written correspondence.

  1. Provides effective training, coaching, and motivation for Level I associates.    Demonstrated ability to be a resource for new and existing associate staff.  Demonstrates best practices and learned skills in order to assist the team and department with improved quality, productivity and performance metrics.
  2. Uses FLEXX and/or CARE and/or NASCO systems, product, 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.
  3. Learns information required to effectively administer service to clients as it relates to inquiries concerning pre-existing condition, knowledge of policies and riders, identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions.


    Required: High School diploma or equivalent. Position requires 2-5 years prior customer service and/or claims adjudication experience.  The incumbent must be cross trained between service and claims adjustment with the ability to handle more complex issues.

    Abilities and Skills: Use of automated systems, PC or CRT proficiency, excellent oral and written communication skills, time management and organizational management skills.  Strong    analytical abilities and problem-solving skills. Ability to work independently and as part of a team in a fast paced work environment for the development of associate staff and the department through effective team skills, quality improvement, productivity, business flexibility and customer retention.

    Preferred: 2-4 years of college in Business or other related education.  Healthcare and/or Insurance industry experience is a must.  Bilingual in Spanish/English is a bonus.

The physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.

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 of up to 25 pounds are occasionally lifted.

Department:  FEP Provider Service Unit


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.

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.

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

Please visit our website to apply:

Please apply before: June 19, 2016

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


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