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Claims-Customer Service Representative-SAT

Employer
Blue Cross Blue Shield of ND
Location
Fargo, ND
Salary
Join our team!

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Job Details

The Claims and Customer Advocate is responsible for providing accurate and timely customer service and claims processing to members and providers. This position must meet and maintain departmental standards for timeliness and accuracy 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.

Essential Functions

  • Provides assistance, service and education to all internal and external members, providers, and customers. Ensure accuracy and timeliness in responding to a variety of inquiries.
  • Process and resolve customer issues with varying complexities, which may include system updates and/or claims research.
  • Strives to understand any claims inquiry through reasoning, plus research via a variety of online and reference tools.
  • Determines appropriate action necessary and documents this process appropriately until inquiry is fully resolved.
  • Reviews each claim to make the appropriate determination on the next course of action. Pays and/or adjusts claims which can then be processed, determines claims situations that need to be transferred or rejects claims that cannot be processed or are contract exclusions.
  • Utilizes and reviews/works a variety of aged reports, medical notes/forms, faxed information, and voicemails to make additional determination on claims for further processing efforts and handles member/provider letters and appeals.

Requirements

Knowledge, Skills and Abilities

Customer Interaction

Intermediate

Decision Making

Intermediate

Communication (Verbal/Written)

Intermediate

Attention to Detail and Accuracy

Intermediate

Collaboration

Basic

Education Requirements

Required: High School Diploma/GED

Preferred: High School Diploma/GED

Field(s) of Study: N/A

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.

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

Other Information

Job Posting Policy 6.05

New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

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 10/17/2018 at 8:00AM CST. No further applications will be considered.

Company

TWO WORDS – MEMBERS FIRST.

That sums up why we’re here. And according to member satisfaction surveys, 95.6% say we’ve done a great job at maintaining that focus.

With that said, there are still mountains to move. America’s health care system needs an overhaul and Blue Cross Blue Shield of North Dakota is taking a lead role. To accomplish that, we need BOLD people who believe they can make an impact.

Are you ready to shake up an industry?

If you’re passionate about taking on our nation’s number one health care concern, there may be a place for you on one of our teams.

Company info
Website
Location
4510 13th Ave. S.
Fargo
ND
58103
United States

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