Claims and Customer Advocate - Federal Employee Program (FEP)

Job Summary

The Claims and Customer Advocate is responsible for providing accurate and timely customer service and claims processing to members and providers. This role performs overall research of both claims and service-related issues and processes these claims and inquiries effectively. This position involves a high level of urgency in resolving complex issues effectively to maintain departmental and company standards, including Member Touchpoint Measures (MTM), First Call Resolution (FCR), Federal Employee Program (FEP)/Office of Personnel Management (OPM) measures, BlueCard measures, and Group Performance Guarantees. This position requires a dual role in the High Mark Health Solutions (HMHS) platform, utilizing multiple and distinctively different systems to perform both roles.

This opportunity is eligible for remote work or a hybrid work arrangement. We empower our employees to find a work style that is best for them.  Click Life at Blue | BCBSND to learn more.

Pay Level: 014

FLSA category: Non-Exempt - Hourly

Essential Functions

• Responds to incoming inquiries received through phone, fax, mail, email and web portals, and makes outgoing calls to provide assistance, service, and education to all internal and external customers.
• Processes claims by reviewing and identifying issues such as pricing, benefits, membership, and coordination of benefits, and works diligently to resolve any problems or discrepancies so claims can be effectively processed in an accurate and timely manner.
• Processes and resolves customer issues with varying complexities by utilizing multiple systems and online resources and collaborating with other internal departments, while meeting claims and service performance and quality metrics.
• Utilizes critical thinking and reasoning skills to interpret correspondence and inquiries. Initiates the processing of claim refunds or adjustments after a full process review has been completed and action has been documented.

 

Knowledge, Skills and Abilities

Customer Interaction

Intermediate

Decision Making

Intermediate

Time and Resource Management

Intermediate

Attention to Detail and Accuracy

Intermediate

Collaboration

Basic

Problem Solving and Resolution

Intermediate

 

Education Requirements

Required: High School Diploma/GED

Preferred: Associate's

Field(s) of Study: Business, Healthcare Administration, or related field

 

Experience Requirements

Required: Minimum of 1 Year

Preferred: Minimum of 2 Years

Experience Details: Minimum of 1 year of customer service, office-related, insurance, healthcare, or related experience is required.

 

Certification, Licensures & Registration Requirements

Title: N/A

State or Agency: N/A

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

 

Physical Demands

Sitting

Constant (90-100%)

Typing/Data Entry

Constant (90-100%)

Telephones and Other Electronic Devices

Constant (90-100%)

Talking

Frequent (60-90%)

Use of Computer

Frequent (60-90%)

Hearing

Frequent (60-90%)

Other Information

Job Posting Policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 10/7/2022 at 8:00AM CST. No further applications will be considered.