Medicare Member Services Blue Shield of California - Woodland Hills, CA Responds to and resolves various customer inquiries via telephone and correspondence, and resolves claims problems within established production and quality standards. Answers incoming calls and written requests for information from members or providers promptly and accurately. Composes routine and non-routine correspondence to answer member inquiries that require a written response. Coordinates with other departments to ensure timely and appropriate responses. Expedites and resolves complex issues and initiates claim adjustments. Educates others on the Blue Shield product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction. Capable of effectively navigating through multiple platforms or applications to efficiently locate information and complete processing tasks. Essential Job Duties & Responsibilities: Successfully completes training which covers some of the following: - May compose routine and non-routine correspondence to answer member benefits/provider inquiries in writing - Coordinates with other departments to ensure timely and appropriate responses - May make membership changes such as member’s primary care physician - Handles escalated calls; may de-escalate calls - Peer to peer coaching /training - Performs inventory reduction, routine to mid-level, (i.e. member inquiries, may initiate claim adjustments, responds to emails, etc.) - May expedite, research, and resolve complex issues - May participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction Job Required Education/Experience Education, Knowledge, skills, competencies, etc: - Successfully meets requirements of live work audit - Has strong customer service experience (especially with phone correspondence) and a proven ability to meet performance standards - Strong organizational skills - Ability to work independently - Ability to mentor others - Ability to interpret the various health plans and any documentation associated with them . Blue Shield of California is committed to remaining a drug-free work place. All positions require a pre-employment background investigation and drug screen. Blue Shield of California https://blueshieldca/
Posted on: Wed, 13 Nov 2013 19:58:32 +0000
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