As the primary contact for our customers, the Customer Service Representative (CSR) is one of the most important positions to our Enterprise. Our ability to provide outstanding service to our members continues to be a top goal for every associate at the Enterprise. For this reason, the Customer Service Representative must embody the service vision, objectives, and values of the organization.
This position requires highly motivated and dedicated personnel accountable for ensuring final disposition of each inquiry in a timely manner while systematically documenting detailed customer information relevant to each customer contact.
To provide the excellence in Customer Service that our Enterprise expects, Customer Service Representatives must demonstrate a thorough knowledge of claims information, group and individual contract benefits, coordination of benefits, provider contracting and membership criteria. This enables our Customer Service Reps to provide accurate and courteous responses to members, policyholders, providers and employer representatives regarding all types of inquiries received via telephone, written or faxed, and in-person customers.
This position may assist the marketing staff with open enrollment and renewal negotiations. Additionally, the Customer Service Representative performs pro active customer initiatives by telephone and makes on site visits to assigned groups as needed.
The Customer Service Representative also must create and maintain an atmosphere of trust and confidence in the administration of policies and procedures of the Enterprise.
The right service for every customer every time.
We strive to make every service experience effective, efficient, customer-centered, timely, and complete.
• Put the customer first in everything that we do.
• Be a customer advocate to help customers quickly resolve any issues.
• Provide information that is easy to access and understand.
• Create a professional environment where we treat our customers and each other with respect, empathy, and courtesy.
• Develop knowledgeable Customer Service Representatives who speak confidently and provider correct and complete information for our customers.
Nature & Scope
The incumbent is part of a team responsible for maintaining good relations with all policyholders, providers, vendors and plan personnel in a friendly and courteous manner. The incumbent must have extensive knowledge of the Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators membership and enrollment guidelines, claims processing, and adjustment functions and medical policy.
The incumbent must learn to operate different systems and be versatile in answering customer and provider inquiries. The Customer Service Representative is expected to be knowledgeable in all products sold by Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators. The person must also be knowledgeable of all correspondence, booklets, newsletters and directories published by or about all entities within the enterprise.
The Customer Service Representative has the authority to make decisions as related to inquiries received from members and health care providers; to implement measures necessary to resolve problems and to communicate a response orally or in written form to the inquirer. This position also has the authority to document and recommend modifications or enhancements, and to generate special reviews for exceptions as permitted by the customer. The Customer Service Representative assists with training of new staff as well as providing continuous coaching concerning any job duty of the CSR or system used by the CSR for internal staff concerning benefits, benefit interpretation and eligibility.
The incumbent acts as a liaison between all support functions and the member/policyholder. This includes researching the problem, concern or inquiry and providing appropriate responses with correct information. Appropriate information may include preparation of periodic reports/data, information, summaries and submits to management with appropriate documentation.
The Customer Service Representative is expected to deal tactfully with interdepartmental communications and is cooperative and open minded in working with others. They must be able to act with a sense of urgency when needed and have exceptional problem solving and analytical skills while being detail oriented. The desire to go the extra mile and provide exceptional customer service is a must.
Skills, Knowledge, and Abilities
1. Ability to multi-task, organize, and prioritize.
2. Ability to work in a structured environment.
3. Ability to work independently and contribute to the achievement of service, production and quality goals of the team.
4. Innovative thinking.
5. Effective verbal and written communication skills.
6. Analytical skills.
7. Dress and present self in a professional manner.
8. Ability to remain calm while engaged in a stressful conversation or situation.
9. Ability to answer written correspondence.
Minimum Job Requirements
1. Must meet at least one of the following:
A. High school diploma or equivalent with experience in a specialized customer service environment.
B. Two (2) years of college (at least 48 credit hours) plus experience in a specialized customer service environment.
C. Bachelor's degree from an accredited college or university.
2. Must successfully complete customer service assessment test.
3. Keyboarding skills.
4. Experience in healthcare, medical provider, insurance, medical supplier, medical terminology, claims processing, and/or medical coding is preferred.
5. Above average communication skills
6. Microsoft Outlook experience
Assessment/Testing needed: Customer service assessment part 1 and 2
This position is identified as level three (3). This position must ensure the security
and confidentiality of records and information to prevent substantial harm, embarrassment,
inconvenience, or unfairness to any individual on whom information is maintained.
The integrity of information must be maintained as outlined in the company Administrative
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented
or detected on a timely basis by employees in the normal course of business. This
position must adhere to the segregation of duties guidelines in the Administrative
PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1. Ability to listen, comprehend what is said, be friendly and courteous.
2. Communicate in a clear and concise manner, both orally and in writing with above average grammar and vocabulary skills.
3. Conduct him/herself in a positive professional manner at all times with customers and team members.
4. Handle confrontational situations with empathy but also in such a manner as to reach fact based objective conclusions and resolve.
5. Handle confidential information with integrity and professionalism within HIPAA Guidelines.
6. Gain conclusive agreement through negotiation.
7. Interact with all levels of internal staff, customers, and providers.
8. Take initiative to perform job functions with minimal supervision.
9. Set personal goals to achieve divisional expectations.
10. Identify areas for process improvement
Arkansas Blue Cross and Blue Shield - 12 months ago
In 2012, Arkansas Blue Cross was named one of central Arkansas’ “Top Work Places” by the Arkansas Democrat-Gazette and...