Account Advocate

BlueCross BlueShield of South Carolina•Columbia, SC

19h•Onsite

About The Position

Coordinate with relevant areas to ensure customers (agents, group administrators, members, etc.) receive outstanding customer service and to ultimately retain customer base. Address issues as they are identified. Resolve and communicate results, concerns and/or problems to management. This position is onsite full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle Columbia, SC 29203. Provide comprehensive service to all assigned groups in a professional manner. Respond to internal and external inquiries pertaining to assigned group(s) received from group administrators, internal management, providers, vendors, various internal departments, etc. Inquiries may be any question related to the assigned group(s), and may include eligibility, benefits, claims, billing, etc. Responsible for ensuring all customer inquiries are resolved in a timely manner. Assist Marketing Representatives with eligibility issues, claims issues, and pharmacy issues on behalf of group administrators and members. Make outreach calls to new groups and existing groups. May travel to groups and benefit fairs to assist marketing. Train claims/customer service staff on benefits, claims processing procedures, and/or and changes specific to the assigned group(s). May support membership, ensuring correct eligibility information is available. Log and track all inquiries received by email and fax. May create and run reports to identify and analyze trends or to resolve issues. Assist in special projects as assigned by management. 50% Directs customer service, claims processing, and/or appeals staff in ensuring prompt and accurate processing of items and inquiries. Develops and supports strategic initiatives to enhance provider and customer satisfaction. 20% Works closely with areas to track performance and develop measures of success. Implements process improvements. 10% Identifies system limitations and serves as project leader on system enhancements and updates. 10% Leads and supports achievement of departmental, divisional, and corporate strategic objectives. Collaborates with other functional areas to resolve multi-functional issues. Provides necessary assistance and resources when necessary. Develops and monitors budget and resources for all assigned areas. Responsible for the selection, training, and development of staff. Ensures excellent customer service is given to employees, customers, management, etc.

Requirements

Four years of directly related work experience.
Bachelor's Degree OR Two years job related leadership experience with claims, customer service or in a healthcare setting.
Proven ability to effectively troubleshoot.
Strong interpersonal skills and demonstrated customer service orientation.
Excellent time management, organizational, and priority setting skills.
Excellent verbal and written communication skills.
Strong analytical and problem-solving skills.
Ability to take initiative and to work with deadlines.
Ability to work independently.
Ability to adapt to continuous change in policies and procedures.
Knowledge of health insurance terminology and its appropriate application.
Microsoft Office.

Responsibilities

Provide comprehensive service to all assigned groups in a professional manner.
Respond to internal and external inquiries pertaining to assigned group(s) received from group administrators, internal management, providers, vendors, various internal departments, etc.
Ensure all customer inquiries are resolved in a timely manner.
Assist Marketing Representatives with eligibility issues, claims issues, and pharmacy issues on behalf of group administrators and members.
Make outreach calls to new groups and existing groups.
May travel to groups and benefit fairs to assist marketing.
Train claims/customer service staff on benefits, claims processing procedures, and/or and changes specific to the assigned group(s).
May support membership, ensuring correct eligibility information is available.
Log and track all inquiries received by email and fax.
May create and run reports to identify and analyze trends or to resolve issues.
Assist in special projects as assigned by management.
Directs customer service, claims processing, and/or appeals staff in ensuring prompt and accurate processing of items and inquiries.
Develops and supports strategic initiatives to enhance provider and customer satisfaction.
Works closely with areas to track performance and develop measures of success.
Implements process improvements.
Identifies system limitations and serves as project leader on system enhancements and updates.
Leads and supports achievement of departmental, divisional, and corporate strategic objectives.
Collaborates with other functional areas to resolve multi-functional issues.
Provides necessary assistance and resources when necessary.
Develops and monitors budget and resources for all assigned areas.
Responsible for the selection, training, and development of staff.
Ensures excellent customer service is given to employees, customers, management, etc.