III (Rochester Region)

Excellus BCBS•Rochester, NY

14d•$24 - $47

About The Position

Based on the book of business associated with this opening, candidates must reside in the Rochester region. Summary: The Account Service Consultant ensures prompt, accurate, and efficient servicing of all Broker, Member, and Employer Group Administrator inquiries. Inquiries may be via telephone, email, written inquiries, and lobby walk-in’s or through on-site visits with an employer group and/or broker. This role provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance Group & Broker satisfaction/retention. The Account Service Consultant maintains constant communication with the Sales staff and other Business Partners throughout the organization. Essential Accountabilities: Level I Responsible for the implementation of new groups, renewals, and conversion of groups to new product lines. Researches, interprets, and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services, and policies in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. Responsible for custom, complicated employer group servicing. Partners with Sales to create and deliver presentations to external customers. Manages any de-implementations associated with a complex group that terminates from our portfolio when applicable. Reviews all group-facing documents and validates for accuracy. This can include, but is not limited to, benefit summaries, summary plan descriptions, Member Contracts, Group Agreements, etc. Partners with Project Management team to support vendor relationships and conversations related to electronic enrollment methods for assigned book of business. Acts as a liaison between the group/broker and internal departments when it comes to new group implementations and renewals. Identifies and responds to issues brought forward either internally or externally and ensures all inquiries will be responded to within 24-48 hours – same business day preferred where possible. Interacts with Operations, Enrollment and Billing, Customer Care, Claims, Advocacy, Clinical Operations, Medical Affairs and Finance/Underwriting Departments to resolve identified issues. Assures that all account data is maintained on a timely and accurate basis such as initial account setup, benefit books, summaries, contracts, etc. Utilizes both standard and custom products in a manual workflow to meet the needs of clients. Validates all group set up and renewal completions. Completes and successfully passes training(s) to support job role/function. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution. Level II (in addition to Level I Accountabilities) Assists with on-the-job training of other Account Service and Sales Account Managers as requested. Support Level I team members with more complex issues. Ongoing participation in meetings, training, and skill development to support career path and individual development plans. Identifies issues, patterns and/or trends generated by external and internal action affecting customer satisfaction and consistently and independently recommends and initiates changes and improvement for process review. Attends meetings and/or trainings as a representative of the Account Service Team and shares the information learned with the Account Service Staff within a reasonable timeframe Handles HIPAA (Health Information Portability and Accountability Act) issues as requested by members through Group Administrators. Specifically, handles all Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels. Level III (in addition to Level II Accountabilities) Assists with tasks assigned by management that require advanced problem-solving skills. Partners with Sales to create and deliver presentations to external customers. Mentors and trains more junior Account Service team members to initiate resolution to all outstanding and/or difficult issues. Acts as a back up to Account Manager when individual is out of the office.

Requirements

In lieu of degree, 2 years of experience in service or healthcare industries. High School diploma or equivalent required. Associates Degree in related field preferred.
Valid NYS Accident and Health license within six months of employment required.
Familiarity with NYS and Federal regulations and underwriting policies and all process flows.
Strong oral/written communication and customer service skills.
Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands.
Ability to complete required internal Medicare Training per Center for Medicare Services within one year of start date.
PC skills essential: spreadsheet and word processing applications, database functions and sales force automation software applications.
Two or more years of experience in a sales operation’s environment.
Valid NYS Accident and Health license.
Knowledge of NYS and Federal regulations and underwriting policies and all process flows.
Demonstrated relationship building skills.
Five or more years of experience in a sales operations environment.
Valid NYS Accident and Health license.
Proficient with NYS and Federal regulations and underwriting policies and all process flows.
Experience creating and delivering client presentations.
Excellent analytical/problem-solving skills.
Ability to travel within the Health Plan service region as necessary to offer support for on-site visits to groups/brokers, open enrollments, training, and/or off-site meetings.
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.

Responsibilities

Responsible for the implementation of new groups, renewals, and conversion of groups to new product lines.
Researches, interprets, and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services, and policies in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements.
Responsible for custom, complicated employer group servicing.
Partners with Sales to create and deliver presentations to external customers.
Manages any de-implementations associated with a complex group that terminates from our portfolio when applicable.
Reviews all group-facing documents and validates for accuracy. This can include, but is not limited to, benefit summaries, summary plan descriptions, Member Contracts, Group Agreements, etc.
Partners with Project Management team to support vendor relationships and conversations related to electronic enrollment methods for assigned book of business.
Acts as a liaison between the group/broker and internal departments when it comes to new group implementations and renewals.
Identifies and responds to issues brought forward either internally or externally and ensures all inquiries will be responded to within 24-48 hours – same business day preferred where possible.
Interacts with Operations, Enrollment and Billing, Customer Care, Claims, Advocacy, Clinical Operations, Medical Affairs and Finance/Underwriting Departments to resolve identified issues.
Assures that all account data is maintained on a timely and accurate basis such as initial account setup, benefit books, summaries, contracts, etc.
Utilizes both standard and custom products in a manual workflow to meet the needs of clients.
Validates all group set up and renewal completions.
Completes and successfully passes training(s) to support job role/function.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution.
Assists with on-the-job training of other Account Service and Sales Account Managers as requested.
Support Level I team members with more complex issues.
Ongoing participation in meetings, training, and skill development to support career path and individual development plans.
Identifies issues, patterns and/or trends generated by external and internal action affecting customer satisfaction and consistently and independently recommends and initiates changes and improvement for process review.
Attends meetings and/or trainings as a representative of the Account Service Team and shares the information learned with the Account Service Staff within a reasonable timeframe
Handles HIPAA (Health Information Portability and Accountability Act) issues as requested by members through Group Administrators.
Specifically, handles all Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels.
Assists with tasks assigned by management that require advanced problem-solving skills.
Mentors and trains more junior Account Service team members to initiate resolution to all outstanding and/or difficult issues.
Acts as a back up to Account Manager when individual is out of the office.