Benefits Operations - CW Account Advisor I

Job Profile Summary

Resolves benefit and claims inquiries via the telephone from our members or providers in the call center. Promotes and maintains a positive company image through direct contact with customers. Complies with all laws and regulations associated with duties and responsibilities.

POSITION PURPOSE

Resolves benefit and claims inquiries via the telephone from our members or providers in the call center. Promotes and maintains a positive company image through direct contact with customers. Complies with all laws and regulations associated with duties and responsibilities.

NATURE AND SCOPE

This role does not manage people. This role reports to: SUPERVISOR, CUSTOMER SERVICE. Necessary Contacts: Enrollment & Billing, Claims, Provider Relations, Benefit Operations, Network Administration, Sales/Marketing, Accounting and Legal departments as well as members, providers, groups, brokers, other plans, insurance companies, Social Security Administration and Centers for Medicare and Medicaid Services (CMS).

Qualifications

Education: High School Diploma or equivalent required or Associate's degree preferred.

Work Experience: 1 year of customer service or medical office experience required. Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC, can be used in lieu of the one year of experience. A certificate in medical office assistant or medical coding can be used in lieu of the one year of experience. Previous experience in a call center is preferred.

Skills and Abilities: Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook, etc.) and related software as other corporate software programs and applications. Demonstrated verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism. Familiarity with medical and health insurance terminology preferred. Conflict resolution skills and remains calm under pressure/stressful situations. Must be able to demonstrate critical thinking and problem solving skills. Demonstrate attention to detail. The ability to actively listen and ask appropriate questions, to effectively understand issues that are presented from customers. Reading comprehension skills are required due to the high amount of direct customer contacts and the need to understand customer contract benefits and training materials. Effective organizational and interpersonal skills are required. Must have the ability to multi-task and handle work independently as well as organize and prioritize multiple customer issues. Ability to take ownership of issues from the beginning, seeking First Call Resolution (FCR). Must be able to verbally communicate on the telephone in a call center environment approximately 95% of the time in the Customer Care Center. Employees may be expected to work during inclement weather or other emergency situations when needed. Must have ability to successfully complete Customer Service training, with demonstrated proficiency in training materials.

Licenses and Certifications: None Required.

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

Reviews and researches billing and healthcare claim inquiries from members and providers, to ensure proper benefits and/or payments are applied correctly; researches multiple computer systems/applications to verify data/information accuracy. Responds to inquiries regarding adjustments, refunds, edits and/or payment registers to ensure completeness, accuracy and customer satisfaction to members or providers. Maintains knowledge of required lines of business, changes to applicable company policies/procedures, recent laws and regulations, and related computer systems to ensure information is current and accurate when providing service to members or providers on the telephone in the call center. Meet Customer Service performance goals/expectations in the areas of efficiency, accuracy, quality, production, customer satisfaction, and attendance. The ability to verbally communicate on the telephone approximately 95% of the time. Additional Accountabilities and Essential Functions The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions. Job duties are performed in a normal and clean office environment with normal noise levels. Work is predominately done while standing or sitting. The ability to comprehend, document, calculate, visualize, and analyze are required.

EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."