Work At Home - Missouri

Full time

R6958

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

Annual incentive bonus plan based on company achievement of goals

Time away from work including paid holidays, paid time off and volunteer time off

Professional development courses, mentorship opportunities, and tuition reimbursement program

Paid parental leave and adoption leave with adoption financial assistance

Employee discount program

Job Description Summary:

The Customer Advocate position is responsible for responding to a variety of inquiries from members and their dependents, hospitals, providers, attorneys and agents. The incumbent will need to interpret multiple contracts in response to benefit and claim inquiries. Researches membership database and billing history to resolve membership issues.

Job Description

EACH DUTY AND RESPONSIBILITY MUST BE PERFORMED IN ACCORDANCE WITH INDIVIDUAL PERFORMANCE SCORECARD INQUIRY AND QUALITY STANDARDS.

Provides a high degree of customer service including receiving and responding to telephone calls, letters or walk-in customers.

Educates and works with members at different health literacy levels with cultural sensitivity.

Enters record of inquiries and related correspondence in computerized tracking system.

Researches applicable medical policy and corporate, divisional, and department policies and procedures. Utilizes information, claims data, and membership records to resolve issues independently or with minimal assistance, when possible within first call

Fully responsible for proactively maintaining knowledge based (i.e. start-up notes, emails, Blue Help updates, etc.)

Maintains confidentiality of all regulated information in compliance with state and federal laws.

Exemplifies professionalism by effectively using proper grammar and spelling when composing verbal and written correspondence that is customer centric, compliant, and adapted to audience.

Recognizes trends or common issues and raises to leadership as necessary. Provides solution options as appropriate.

Recognizes and uses time management techniques appropriately to manage competing projects and priorities to meet customer needs and deliver on commitments in a timely manner.

Delivers positive customer and member experience on a consistent basis

For FEP positions must complete additional FEP training program for FEP system and procedures.

Provides resolution with a service level that ensures members and customers feel valued and understood

Minimum Qualifications

High school diploma or general education degree (GED).

2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience

Advanced Keyboarding Knowledge

Intermediate knowledge of Microsoft Office

Preferred Qualifications

Associates degree from college or technical school.

Previous experience with on-line customer service applications

Medical terminology and ICD/CPT coding knowledge

Experience taking Blue KC member calls

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!

Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to Recruitingteam@bluekc.com .

EOE/Veterans/Disability

Affirmative Action Employer

E-Verify Participation (https://bluekcmemberportal.azureedge.net/pdf/2024/E-Verify\Participation\Poster\Eng\Es.pdf)

Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies

IER Right to Work (https://www.e-verify.gov/sites/default/files/everify/posters/IER\RightToWorkPoster%20Eng\Es.pdf)

FMLA

Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)

Blue KC

Latest Jobs

Customer Advocate I