Customer Advocate Phone Specialist - BC Home- Hybrid

Requirements

• REQUIRED QUALIFICATIONS
• Required Work Experience
• 1 years of experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field
• Required Education
• High-School Diploma or GED in general field of study
• Required Licenses
• N/A
• Required Certifications
• Preferred Work Experience 2 year(s) of experience in claim processing, customer service, call center, health insurance, medical office, or other healthcare-related field
• Preferred Education Associate's Degree in general field of study
• Preferred Licenses A valid Arizona driver license with an acceptable driving record if travel is required (e.g. regional employees)
• Active, current, and unrestricted AZ Department of Insurance Health Insurance License for member concierge, Mi Consejero Azul, or areas supporting sales
• Preferred Certifications
• ESSENTIAL job functions AND RESPONSIBILITIES
• Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
• Answer a diverse and high volume of health insurance related customer calls and correspondence daily.
• Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Explain to customers a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
• Document and record facts in regard to inquiries and correspondence by updating BCBSAZ files and system.
• Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
• Utilization Management-related accountabilities for FEP staff include: Review of healthcare service requests for completeness of information
• Collection and/or transfer of non-clinical data
• Utilization Management-related accountabilities for Provider Assistance staff include: Review of healthcare service requests for completeness of information
• Collection of defined clinical data using structured scripts or tools
• Activities that do not require interpretation of clinical information or decisions regarding utilization of any clinical criteria for handling of a request for healthcare services or treatment
• Travel may be required for employees in regional offices
• The position requir

Benefits

Additional Information

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona. Purpose of the job This is a highly specialized customer service position with an emphasis on excellence, privacy, compliance and versatility within the health insurance industry. The position will identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person. Scope of the position includes accountabilities that support the following programs: 1. Utilization Management, 2. Member Relations and 3. Network Management.

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