Client Services Support Analyst- Rx Calls

Capital Blue Cross•Harrisburg, PA

About The Position

The CS Client Services Support Analyst is the front-line team responsible for handling all customer inquiries through multiple channels primarily inbound phone (i.e. web, electronic, and/or face-to-face) by using resources, materials and tools with accuracy and precision. Conduct research and provide problem-solving support to the Members, Providers, Brokers and Sales serving the Small, Large and Major Market Groups as well as our Individual Account plans. Technical and administrative support as well as serving as a liaison to the Vendor contacts regarding our plan benefits and policy issues. Responsible for reviewing, identifying, and analyzing policies, procedures, and contract issues that impact both departmental and/or Plan wide functions/operations. Prepare recommendations on all issues; root cause, action steps taken toward resolution. This position is responsible for providing efficient, courteous, professional quality service to Members, Providers, Group Leaders, Plan personnel and Brokers/Sales in a timely manner. Inquiries are received via Phone, Internet, E-Mail, and Internal Routing Queues and or Vendor applications. Ensures compliance with organizational and regulatory requirements. Topics pertaining to enrollment, billing, benefits, and claims for various types of prescription coverage offered by Capital BlueCross- Commercial Plans, POS, PPO, HMO, CHIP and Medicare Programs. Knowledge of Medicare, PPACA, Healthy PA, CHIP, prescription, Benefits Management, and other programs administered/supported by Capital BlueCross and Avalon. This Support Analyst will be responsible for effectively presenting and discussing our products and services, creating, and maintaining positive relationships and for exceeding quality, productivity, and ultimate performance goals. This Support Analyst will be required to initially attend an extensive training class in addition to ongoing periodic refresher trainings to service our customers (i.e. Members/Providers/Group Leaders/Brokers/Sales) as business needs permit. Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

Requirements

Demonstrates ability to communicate effectively and professionally both verbally and in writing with all levels of internal/external personnel in order to respond to customer inquiries ranging from routine to complex and involving sensitive subject matter
Demonstrates ability to understand and interpret detailed policies and procedures and to be able to apply them to various situations. This includes thorough understanding of CBC’s responsibility to maintain privacy of Protected Health Information as required by the Health Insurance Portability and Accountability Act.
Demonstrates ability to work independently, be flexible and react appropriately to changing job assignments and work environments.
Demonstrates analytical, organizational, and problem-solving skills in order to accurately and efficiently identify, analyze and respond to customer/provider inquiries, as well as identify and analyze trends and discrepancies.
Familiar with, or ability to, operate a PC and associated software; Microsoft Word, Excel, etc., phone equipment, calculator, fax, copier, and other department required hardware.
Demonstrated competency in Windows (Outlook, Word, Internet Explorer, Excel and PowerPoint), SharePoint, and Sales Force.
Above average reading, writing and arithmetic skills required (reading/math comprehension)
Knowledge of benefit programs administered and/or supported by Capital BlueCross. Includes Medicare Advantage, Medicare Part D and Medicare Supplemental Programs, Dental, Vision, Chiropractic, Prescription Drug, Benefits Management, and Disease Management.
Knowledge of the PBM and Facets health plan administration processing systems as well as online files for determining enrollment, billing, and benefits. Knowledge of benefits administration policies, customer billing processes, claims processing and general procedures.
Knowledge of ERISA, Act 68, and BCBSA MTM, PPACA, HIPAA quality and timeliness guidelines and standards to ensure they are consistently met or exceeded
Knowledge of Account Administration regulations, policies and procedures pertaining to Capital BlueCross and transfer of enrollment information to all our vendors
Knowledge of multiple online inquiry systems and coding structures of files to interpret data used in responding to inquiries and Sales Force cases.
3 years customer service or correspondence experience or experience/training in a writing-intensive role is required.
High School degree or equivalent.

Nice To Haves

Experience with customer interaction preferred.
Pharmacy Technician certification a plus.

Responsibilities

Inbound Telephone Calls (i.e. AHT, ASA, ACW metrics) including necessary research and review of customer inquiries as related to one of our Prescription Drug LOB ( Line of Business) Determines appropriate action by reviewing and interpreting applicable policies/procedures that are within the established regulatory requirements. Utilizes the PC, manuals, online reference materials, Imaging, etc., to obtain benefits, enrollment and claim information.
Ensures the satisfactory resolution of routine and complex PBM (Pharmacy Vendor Manager) inquiries including, but not limited to, benefits, claim filing and processing, collection issues, enrollment discrepancies, legal requests, Medicare Secondary Payer, Plus Billing and payment requests, Third Party Administrators, COBRA, reinstatements, conversions, refunds, new enrollment, transfer situations, student certifications, handicapped dependents, for all lines of business administered and supported by Capital BlueCross and Avalon. Conducts specific job-related instructional sessions as requested by Manager.
Be able to prioritize work, communicate and share information with the team as necessary. Respond to customers inquiries via telephone, correspondence, on-site, Fax, Secure IT, E-mail and personal interviews from individual customers, group administrators, providers, Capital BlueCross personnel, Host Plan personnel, attorneys, and outside entities working on the customer's behalf.
Monitors Vendor related inquiries utilizing various system generated reports for accurate and timely resolution to ensure customer satisfaction and compliance with LOS (Local Operations Scorecard), PPACA, ERISA, and Act 68 quality, and timeliness guidelines.
Provides clear and concise instructions to the appropriate Plan area, in the approved format (e.g., electronic, on-line or hard copy forms, telephone contact) for the resolution of the issues.
Contacts the appropriate internal/external entities (e.g., groups, providers, Marketing, Legal, Host Plans, Vendor contacts etc.) to obtain information and initiate necessary action.
Enters all information necessary to update the Ernie Cases, PBM Application, Sales Force Case, or Work Desk when appropriate, for tracking inquiry/Sales Force activity and keep notes updated on progress through resolution. Utilizes the system to obtain background information and prevent duplication of effort.
Report trends to management that may indicate processing problems, lack of documentation or appropriate information concerning claims, enrollment areas, benefits, policies and procedures.
Assists/participates with Marketing personnel and the broker community in the support of customer needs by researching and communicating information to other Company personnel or directly to the customer. May attend or participate in marketing related activities as a representative of Capital BlueCross (e.g., open enrollment, on-site visits, etc.).
Performance standards, business metrics, and process improvements to include: Complete ongoing training to stay abreast of product, service, and policy changes. Improve our quality of work daily by learning and employing new skills. Recognize, document, and alert the Manager and Team Leads of trends in customer service inquiries. Conduct yourself in a manner consistent with the values of the organization