Cust Care Rep I - Multi - Albany, NY 8/31 - (US-NY-Albany - 12288)

Minimum Education: Tech School
Job Type: Full Time
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Empire BlueCross
, a proud member of the WellPoint family of companies, is a distinguished leader in the health insurance industry. As we build on our 70-year history serving the health insurance needs of New York State, we are focused on becoming indispensable to the customers and communities we serve and providing a rewarding career for our talented and diverse workforce.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can

The Customer Care Representative I

Functions on a learning curve to become fully proficient in all aspects of customer service, claims and/or membership issue resolution. Performs research and analysis, advocating on behalf of customers through whole case methods. Learns to provide full service to members, providers, group administrators, and brokers by processing health care claims, handling inquiries, and/or performing membership functions. Performs at least two of the three functions routinely. Essential duties to include, but are not limited to:
* Receives inbound telephone calls or paper and electronic claims from members and providers.
* Resolves issues for members, providers, group administrators and brokers.
* Analyzes the situation and completes research to ensure no rework or follow-up issues.
* Applies knowledge of policies and procedures, products, legislation and claims workflow.
* Interacts with systems to ensure claims are paid or denied based on terms of contract.
* Initiates interaction with other areas to ensure claims are handled properly and thoroughly.
* Interprets claims to determine primary or secondary liability and recognize when additional information is needed.
* Makes decisions on claims payment while considering benefit status, provider status, and impact on Wellpoint, the provider and the member.
* Performs other duties as assigned.

Skills:
* High School diploma or GED and three to six months experience in an automated customer service environment or equivalent combination of formal education and relevant experience.* Demonstrated ability to access and interact with automated systems and to use them efficiently.* Demonstrated ability to operate necessary equipment including calculator, copier and computer keyboard.* Demonstrated ability to acquire and perform progressively more complex skills and tasks in a production environment.* Demonstrated ability to listen effectively, use probing skills to obtain relevant information and establish rapport quickly with customers and co-workers.* Excellent interpersonal skills.WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2008 DiversityInc magazine Top 50 Company for Diversity.

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