Member Service Representative

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Deliver exceptional, courteous, and professional service to members, providers, group administrators, brokers, Plan staff, and the general public.

• Address inquiries received via telephone, fax, written correspondence, email, internet messenger, and in-person interviews.

• Handle enrollment, billing, benefits, and claims inquiries across various coverage types.

• Investigate and analyze customer inquiries utilizing policies, procedures, PC systems, manuals, and Image.

• Resolve routine and moderately complex issues related to benefits, claims, billing, enrollment, COBRA, Medicare Secondary Payor, and similar topics.

• Provide clear guidance to relevant Plan departments for issue resolution.

• Liaise with internal and external parties to gather information and initiate required actions.

• Respond verbally or in writing with precise and timely information.

• Monitor inquiries to ensure prompt and accurate resolution while maintaining customer satisfaction.

• Update records in Facets or Inquiry Control System to track inquiry actions and their status.

• Report trends in inquiries to management.

• Assist Marketing personnel and brokers by researching and communicating customer-related information.

• Engage in marketing initiatives such as health fairs, seminars, open enrollment, and on-site visits.

⛳️ Requirements

• High school diploma or G.E.D.

• One year of customer service experience.

• Ability to comprehend and interpret detailed policies and procedures and apply them to various scenarios.

• Comprehensive understanding of Capital Blue Cross’s obligation to maintain the privacy of Protected Health Information as mandated by HIPAA.

• Capacity to work independently, remain adaptable, and respond appropriately to changing job assignments and environments.

• Strong and professional verbal and written communication skills.

• Analytical, organizational, and problem-solving capabilities.

• Proficiency in using telephone systems such as Interactive Voice Response and Automated Call Distribution.

• Familiarity with PCs and the Microsoft Office Suite.

• Ability to perform sedentary tasks that involve sitting, talking, hearing, keying, repetitive motions, and close visual inspection of documents and screens.

🏝️ Benefits

• Medical, Dental & Vision coverage.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Flexible work environment.

• Training and continuing education.

• Opportunities for community volunteering.