Member Services Representative

Member / Provider Services Representative

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."

The Member / Provider Services Representatives ("MSRs" / "PSRs") are the front-line team at Capital BlueCross ("CBC") and are responsible for handling all customer inquiries through multiple channels (i.e., phone, web, electronic, and/or face-to-face) by using resources, materials and tools with accuracy and precision. This incumbent 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 incumbent 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) as business needs permit.

Responsibilities and Qualifications

• Manage telephone, electronic, and face-to-face interactions professionally, efficiently and with excellent communication skills.
• Effectively present and discuss the products and services to external and internal customers with integrity and understanding and accuracy with every interaction.
• Focus on customer retention through first call resolution of concerns and enhancement of the member experience.
• Establish and maintain positive relationships with customers on behalf of the company by taking personal and complete responsibility for each customer interaction.
• Ensure all customers' needs are completely met, timely, without elevation if possible.
• If business needs permit, support the efforts of CBC sales representatives by conducting onsite and/or community-based educational meetings.
• Large emphasis on quality, productivity, adherence to schedules, handle time, and not negatively affective and jeopardizing CBC customer relations, internally and externally.
• Adaptability to use of soft skills and call strategies.
• Complete ongoing training to stay abreast of products, services and policy changes.
• Improve quality of work on a daily basis by learning and employing new skills or adapting previous processes to mirror the fit-for-excellence company culture.
• Recognize, document, and alert supervisors of trends in customer calls.
• Conduct self in a manner consistent with the values of the organization.

Skills:

• Must possess basic reading and arithmetic skills (reading and math comprehension).
• Must possess above average verbal and written communication skills.
• Demonstrated competency in computer programs such as internet browsers, Microsoft Outlook, Word, Excel, PowerPoint, etc.
• Ability to present a positive and cooperative attitude via multi-channel connections with customers.
• Ability to deliver 'delightful' and effective customer service to enhance the member experience and build customer satisfaction and loyalty with customers.
• Ability to actively listen paired with the ability to demonstrate empathy for customers.
• Be service and solution oriented by actively looking for ways to help.
• Must possess a strong attention to detail and an interest in preventing errors.
• Ability to effectively de-escalate upset callers with minimal supervisory intervention.
• Demonstrate ability to collaborate with others and work as a member of a team.
• Ability to thrive in a dynamic working environment, multi-task, and adapt quickly.
• Ability to accept feedback, learn, and adapt from guidance to be successful.
• Have a strong work ethic, passion for our products and our customers' experiences.
• Must be able to meet quality, productivity, and behavior expectations.
• Have the capacity to up-sell and speak highly of our products and company.

Knowledge:

• Knowledge of company and products in order to up-sell and speak highly of our products and company

Experience:

• 1 year of customer service experience.
• Recent tele-commuting experience a plus.

Education and Certifications:

• Must have a High School Diploma or GED.
• College degree or professional certification (Medical Assistant, Certified Professional Coder, Pharmacy Technician) a plus.
• Bi-lingual (Spanish) a plus.
• License to sell (a plus, may be required for advanced positions).

Work Environment:

Call Center environment

• Qualified candidate must be flexible to work any varied shift schedules that may span anywhere between 8:00 a.m. to 8:00 p.m., any day of the week
• Minimum Internet Service Provider (ISP) speed requirements for work at home: Approximately 15Mbps download and 5Mbps upload per person working at the remote site (home). Latency (PING) under 150ms.
• Satellite internet is typically not sufficient for real-time communication with tools that support voice or video.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

Other:

• Key Interfaces:
• Salesforce
• Facets
• Bridges
• Workflow
• Microsoft Office (Outlook, Word, Excel, PowerPoint)
• Availity
• NICE InContact
• Workbench
• Prime RxClaims
• TruCare

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.