CareFirst–Account Service Non-Sales Representative


Job Title:                    Representative, Account Service Non-Sales

Location:                    Maryland or Washington, DC office

Career Band:             Band A

Job ID#:                      8806


Please note:  This position can be filled in the MD or DC location.  Also this position may be filled as an Acct Service Rep l or ll, depending on candidates work experience and business needs.


This position is responsible for providing dedicated service support to Brokers and the benefit administrator contacts for CareFirst accounts.  Support includes interpreting benefits, providing support to administrative offices handling complex cases for their employees, investigating issues, explaining managed care processes, handling delicate cases for the client group and any special processes the account requests. Provides technical and account service and enrollment support.   Responsibilities also include attending and/or conducting Service and Enrollment meetings at the employee and benefit coordinator level.  The incumbent is a subject matter expert in support of claims processors, adjustors, customer service representatives, OPL analysts, etc. and provides support to those individuals in conjunction with department supervisors to ensure continuous improvement to job knowledge, quality, and productivity to better serve CareFirst customers.   Develops and maintains a strong relationship with Brokers, account management and account support staff.


Under the direction of either a Manager or a Supervisor, the essential duties and responsibilities include, but are not limited to, the following:

  1. 30% Provides service to Brokers and account administrators to diffuse potential crisis situations by resolving service problems or complaints; interacts with other departmental staff to coordinate matters involving retention, systems issues, or benefit administration. .  Facilitate open enrollment meetings and health fairs throughout the year that includes training to internal staff and State of Maryland agency coordinators.
Assists the sales area with renewals providing benefit interpretive support and attending account open enrollment meetings. Interacts with other departmental staff, vendors and subsidiaries to coordinate matters involving service systems issues or benefit administration.
2. 30% Keep weekly and monthly statistical reports on issues involving accounts such as appeals and correspondence?  Responds timely to the formal first level appeals for Service and Enrollment.
3. 15% Acts as support to the supervisor in handling service issues and irate cases from the accounts.  This involves but is not limited to investigation, follow through to recommended resolution and follow up with the customer. Acts as a department contracts and benefit expert to the operations division on accounts that are represented in the meetings. Assists with training and provides updates to the call center. In the absence of the Supervisor, supports the associates with questions and concerns.
4. 10% Represents Service & Claims Operations at local Operations meetings.  This includes biweekly, monthly account meetings and resolving any open objectives from the accounts and Vendor.
5. 10% Keeps the Operations areas, both service and claims informed of any issues or benefits changes impacting the represented accounts. This includes e-mail messages, memos to employees, information forwarded to the training department and attendance at meetings.  Interacts with the Account regarding changes to the Open Enrollment documentation.  Coordinates communication for Enrollment and Service. Provide sign off approval of the Open Enrollment material.
6. 5% In critical times providing an “all hands on deck” support in the Call Center which could include taking customer calls as requested.  Provide benefit and application support to the Customer Service department.



Required: High school diploma or equivalent and 4 plus years of customer service experience in health insurance/managed care industries is required.

Abilities/Skills:  Knowledge of CareFirst BlueCross BlueShield products, claims and enrollment is required.  PC skills are required: experience with email, Work, and mainframe inquire screen functions.  Ability to effectively articulate and communicate verbally and in writing with all levels of customers, both internal and external, is a must. Incumbent will have the ability to perform in a fast paced environment.  Ability to be creative with customer relations to support customer and departmental needs.  Ability to work flexible hours.

Preferred:  2 – 4 years’ experience dealing with complex customer service issues, irate customers and seeing cases through multiple steps to completion and satisfaction for the customer


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.


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

The employee 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 employee must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Department:  Small Medium SBU Broker Service

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

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

Please apply before:  July 28, 2016

Please visit our website to apply:


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