Customer Service Specialist

Job Title

Mentor servicing representatives to ensure the best customer experience by supporting representatives after they complete classroom training; completing quality assurance audits that ensure timeliness, accuracy, professionalism, and an optimal customer experience; and providing timely, relevant coaching in professional and constructive manner. Be available at all times for representative's questions and circulates the floor periodically every day to listen to conversations and provide instruction.

Proficient in analyzing problems and creating end-to-end resolution. Must have thorough and comprehensive working knowledge of HMSA's plan provisions, eligibility requirements, benefits, claims processing, medical policies, payment policies, and administrative policies. Take ownership of every customer interaction as the subject matter expert to ensure the customers' needs are resolved in every instance with just one contact. This involves coordinating with all areas within HMSA as well as external contacts including providers, employers, third party administrators, and other insurance companies.

Independently exercise judgment to effectively manage inquiry volume by directly supporting inbound calls and other servicing channels while at the same time providing the highest level of service to customers. In concert with the Contact Center management, help to ensure the Blue Cross Blue Shield Association's Member Touchpoints Measures related to First Call Resolution and other performance guarantee and industry standard measures such as inquiry accuracy, inquiry resolution timeliness, abandonment rate, average speed to answer and Grade of Service are met or exceeded.

Research complex calls and benefits that require more time or investigation to reach resolution. Create requests and coordinate resolution for customer complaints and issues, such as an individual consideration, HMO-G, grievance, and appeal requests.

Generate monthly reports and analysis on representatives' key performance indicators and research drivers on performance trends such as performance indicators that are above and below average. Review with supervisors the representatives who exemplify best practices or areas where improvement is needed.

Personally handle elevated irate/complaint calls from customers. Resolve complaints by assessing the root cause, providing the appropriate resolution, and evaluating the effectiveness of HMSA's policies and procedures. Provide feedback to the staff, internal HMSA departments, and management.

Collaborate with management staff and peers in activities that support/accomplish HMSA's mission and department goals. Performs all other miscellaneous responsibilities and duties as assigned or directed.

Associate's degree and three years of customer servicing experience; or an equivalent combination of education and related work experience. Strong verbal, written, and interpersonal communication skills. Strong critical thinking, researching, decision making and problem-solving skills. Basic working knowledge of Microsoft Office applications. Including but not limited to Excel, Word, Outlook, and PowerPoint.