Service Specialist
Horizon Blue Cross Blue Shield of New Jersey - Mount Laurel, NJ

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This position is responsible for providing an array of special services; to include field visits, inquiry resolution, group orientations, assistance at applicable workshops, and telephone calls to accounts to review and explain benefits. From the field visits this position must be prepared to report on trends and concerns of the group accounts and subscribers.

Responsibilities:
  • Responds timely and proactively to group account telephone calls by reviewing account file to pre-determine likely concerns, needs or problems; calls account to collect further information or to ascertain their perspective; determines course of action and arranges visits with accounts if appropriate and necessary.
  • Refers group account-initiated inquiries to appropriate operating area(s) in order to service account's concern, need, situation or problem expeditiously.
  • Identifies where inquiry should be addressed. Contacts personally or by telephone appropriate operating area(s) regarding group account's inquiry (inquiries include enrollment and claims processing).
  • Follows-up in writing with operating area(s) to ensure group account satisfaction.
    Maintains follow-up file on those inquiries regarding further action on incumbent's part.
  • Identifies trends in the group account marketplace in order to provide meaningful reports to management based on a field service perspective.
  • Based on field visits and contacts with various group accounts, brings to management's attention noticeable trends (recurring needs, concerns, situations and problems) which affect service conservation.
Compliance Statement:
  • Demonstrates knowledge and understanding of the laws, regulations and policies that pertain to the organizational unit's business and conforms with these laws, regulations and policies in carrying out the accountabilities of the job.
Core Competencies:
The target competency level for the SERVICE role is "Applying" for the following core competencies.
  • Analytical Thinking
  • Business Savvy
    Managing Change
  • Multidirectional Communication
  • Service Quality
  • Shared Leadership
  • Speed and Agility
  • Team Work
  • Technology Proficiency-Require minimum two (2) years of field experience selling or servicing insurance contracts.
  • Require experience contacting and meeting company officials for the purpose of resolving group account needs, concerns, inquiries and/or problems.
  • Experience must include management through executive level contact.
  • Prefer experience servicing or selling health insurance.
Above to be determined by reference check and during structured interview.

Knowledge

(To be determined during structured interview):
  • Knowledge of health care industry required.
  • Knowledge of Horizon BCBS products and services preferred.
  • Knowledge of HBCBSNJ customer service processes preferred.
  • Knowledge of insurance claim and membership systems required.
  • Knowledge of medical terminology required.
  • Knowledge of UCSW preferred.
  • Knowledge of Claims Policy guidelines preferred.
  • Knowledge of Microsoft Office Suite required.
Skills and Abilities:
  • Requires the ability to understand and use language correctly.
  • Requires keyboarding proficiency.
  • Requires the ability to perform basic arithmetical calculations.
  • Requires the ability to read, understand and interpret written materials.
  • Requires the ability to apply reason in order to determine the appropriate arithmetical operation for solving a problem.
  • Requires the ability to analyze information and to understand and apply rules and procedures.
  • Requires the ability to compose business letters.
  • Strong verbal and written communication including the ability to clearly communicate technical information to all levels of internal management and external stakeholder. Must be able to detail member-specific issues through the development of individual correspondence for each case, explaining all issues in a comprehensive, understandable fashion.
  • Requires strong telephone/interpersonal skills, strong conflict resolution skills and the ability to remain professional during difficult interactions with customers.
  • Excellent interpersonal skills (i.e. active listening).
    Strong research, investigative, analytical, decision making and problem solving skills.
  • Ability to perform in high pressure situations.
  • Ability to multitask.
  • Ability to manage and diffuse irate callers.
  • Time management skills.
Special Licenses and Certifications:

Must be licensed to drive an automobile in the state of New Jersey - to be determined by reference check.

Horizon Blue Cross Blue Shield of New Jersey - 22 months ago - save job