Member Services Representative Level 1

Job Description Summary:

Job Description:

Blue Cross Blue Shield of Wyoming Job Description
Job Title Member Services Representative Level 1
Job Code 009Q
Reports To Supervisor of Member Services
Department Member Services
Last Revision Date September 2018
Revised By Renee Dilly

GENERAL PURPOSE
Handles inquiries by telephone and/or email from providers in a customer service center. Troubleshoots and resolves provider complaints. Ensures that responses to inquiries are completed timely and according to established service and quality standards.

ESSENTIAL DUTIES/RESPONSIBILITIES [Core 25d]

• Works toward quality initiatives.
• Resolves provider inquiries and complaints via written and/or telephonic communication in a timely and accurate manner.
• Records all inquiries into the computer system for a permanent record.
• Initiates adjustments for services not properly processed by forwarding to appropriate area.
• Utilizes and understands computer screens to provide accurate answers.
• Works closely with co-workers when necessary to research answers to inquiries.
• Elevates issues to next level as appropriate.
• Strives to resolve provider concerns in a single interaction.
• Meets all production, quality and adherence standards. Attends all required training sessions.
• Other duties as assigned.

OTHER DUTIES/RESPONSIBILITIES

• As needed: handles telephone monitor, switchboard and front desk.

SUPERVISORY DUTIES

• None

JOB QUALIFICATIONS

KNOWLEDGE, SKILL & ABILITY: [Core 25b]

• Must possess good telephone skills
• Must be able to comprehend and explain BCBS contract language
• Must be able to comprehend provider contract language.
• Demonstrates good organizational and time management skills with strong communication skills
• Is able to deal with demanding, stressful situations

EDUCATION, LICENSURE, OR FORMAL TRAINING: [Core 25a & 25c]

• High school degree or equivalent. Company will provide job related training pertaining to company unique information.

EXPERIENCE: [Core 25a]

• Prior Customer Service experience is preferred.

MATERIAL AND EQUIPMENT DIRECTLY USED:

• Computer, telephone, fax machine

WORKING ENVIRONMENT/PHYSICAL ACTIVITIES:

• Works in Member Call Center sitting at desk for entire work day. Must man phones with periodic relief.

ACCESS TO PROTECTED HEALTH INFORMATION (PHI)

• Access to PHI is broad due to job function requirement of responding to customer inquiries relative to claims payments, eligibility, contract benefits and other inquiries.

Blue Cross Blue Shield of Wyoming is an EOE, M/F/Vet/Disabled employer. Blue Cross Blue Shield of Wyoming uses
E-Verify to confirm employment eligibility.