Member Support Rep, GP

Horizon Blue Cross Blue Shield of New Jersey • Newark, NJ

88d • $43,900 - $58,800

About The Position

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. This position is responsible for resolving escalated member inquiries by phone or through written correspondence. The position works closely with Call Center Operations to help coordinate an excellent member service experience for members.

Requirements

• High School Diploma/GED required.
• Call center/customer service experience within the health insurance industry required.
• Strong oral and written communication skills.
• Good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Excellent customer service skills including the ability to manage and diffuse irate calls.
• Ability to work in a high pressure, fast-paced environment.
• Good presentation skills.
• Project Management Skills.
• Excellent interpersonal and organizational skills.
• Good Investigative and analytical skills.
• Ability to multitask.
• Time management skills.
• Flexibility and adaptability.
• Ability to work effectively within a team environment.

Responsibilities

• Receive escalated member inquiries via phone, fax, mail, e-mail, online, social media, etc.
• Probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry.
• Review computer systems and/or other reference materials to complete verification process and ensure all privacy protocols are met.
• Initiate investigation process based on the nature of the inquiry (claim, member information, benefits, enrollment, appeals, authorization, etc.) and work with other areas within the organization to resolve the issue.
• Accurately document member inquiries and actions taken in accordance with departmental quality guidelines to ensure appropriate follow up.
• Follow up on unresolved issues within set timeframes.
• Identify trends and begin root cause analysis of systemic issues/problems.
• Escalate trend information to management on a timely basis.
• Perform outbound calls to ensure member satisfaction and review customer service tickets to review proper documentation and accuracy.
• Responsible for updates on Primary Care Physician (PCP) changes and facilitating fulfilment of requests to comply with 504 requirements.
• Conduct MLTSS member survey for feedback on case manager visits.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED