Claims and Customer Advocate - Federal Employee Program (FEP)

All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

 

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

 

Work environment

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. Learn more at Life at Blue | BCBSND.

This position is eligible for internal and external applications. 

 

Pay information

Pay Level: 014

FLSA Category: Non-Exempt-Hourly

 

A day in the life

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.

 

Your responsibilities will include:

• 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.

 

What you need to succeed

• A High School Diploma or GED with at least 1 year of customer service, office-related, insurance, healthcare or related experience is required. 
• Shows interests in understanding the needs and expectations of customers. 
• Makes good decisions based on a mixture of analytical thinking, experience and judgement.
• Sets priorities and goals to achieve maximum results from available resources and time.
• Pays close attention to the details of all work and strived for a high level of accuracy.
• Coordinates well with other parties to accomplish set goals.
• Resolves problems, makes suggestions and implements process improvement. 

 

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

 

Benefits and perks

• Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
• Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

 

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 2/3/2023 at 8:00 a.m. (CT). No further applications will be considered.