Producer Support Specialist

Position Description

Capital Blue Cross has an exciting opportunity for a Producer Support Specialist  to join our award-winning organization. Since 2014, Capital Blue Cross has scored higher than all health insurance providers publicly measured in the American Customer Satisfaction Index (ACSI) and is proud to be named a Best Places to work in PA, Harrisburg Magazines' Simply the Best, and Highest Member Satisfaction J.D. Power Award.  The Producer Support Specialist will respond to producer inquiries on the first call with complete resolution within 24-48 hours. The specialist will respond accurately, conduct research, and provide problem-solving support to enable an effortless experience for CBC's commercial small group customers. This support specialist will function as part of a team dedicated to assigned preferred and select producers to provide a personalized experience to drive growth and retention in the non-large business segment. The specialist will be responsible for answering inquiries, driving first call resolution, completing eligibility requests, assisting with Salesforce enrollment/plan changes, and completing minor claim adjustments. This individual will use complex service skills to take control of the calls, instill confidence in the call and defuse highly emotional situations leaving the producer with a positive view of CBC and the service provided. This individual will demonstrate deep working knowledge of Facets, CBC medical, pharmacy and ancillary lines of business, claims processing and enrollment and billing functions-all of which the specialist will use to resolve producer inquiries during the initial inquiry and with minimal hand-offs or need for call backs. The specialist will review, identify and analyze policies, procedures and benefit contract issues that impact both departmental and/or Plan wide functions/operations. Inquiries may be received via all channels including phone, Salesforce, internet, email and Facets routing queues. The Producer Support Specialist ensures compliance with all organizational and regulatory requirements. These compliance requirements pertain to enrollment, billing, benefits, and claims for benefit coverage offered by Capital BlueCross and its family of companies.

Responsibilities and Qualifications

Duties and Responsibilities:

• 40% - Answers producer calls and inquiries (benefit coverage, eligibility, issues and payment) striving toward first call resolution and timely responses within 24-48 hours or receipt. Determines appropriate action by reviewing and interpreting applicable policies/procedures that are within the established regulatory requirements. Utilizes Salesforce, PC, manuals, online reference materials, Imaging, etc., to obtain benefits, enrollment and claim information.
• 20% - Ensures the satisfactory resolution of complex inquiries including, but not limited to, benefits, claim filing and processing, collection issues, enrollment discrepancies, legal requests, Medicare Secondary Payer, Plus Billing and payment requests, Third Party Administrators, COBRA, reinstatements, conversions, refunds, new enrollment, transfer situations, student certifications, handicapped dependents, for all lines of business administered and supported by Capital BlueCross and its family of companies.
• 15% - Responds to producers in a professional and articulate manner using multiple modes of communication. Able to prioritize work, communicate and share information with the team as necessary.
• 10% - Enters all information necessary to update the Facets inquiries, Sales Force Case, or Work Desk when appropriate, for tracking inquiry/Sales Force activity and keep notes updated on progress through resolution. Utilizes the system to obtain background information and prevent duplication of effort.
• 5% - Report trends to management that may indicate processing problems, lack of documentation or appropriate information concerning claims, enrollment areas, benefits, policies and procedures.
• 5% - May attend or participate in producer related activities in support of commercial sales as a representative of Capital BlueCross (e.g., open enrollment, on-site visits, etc.).
• 5% - Performance standards, business metrics and process improvements to include:@@Complete ongoing training to stay abreast of product, service and policy changes@@Improve our quality of work on a daily basis by learning and employing new skills@@Recognize, document and alert management of trends in customer service inquiries@@Conduct yourself in a manner consistent with the values of the organization.

Skills:

• Demonstrates ability to communicate effectively and professionally both verbally and in writing with all levels of internal/external personnel and producers in order to respond to customer inquiries ranging from routine to complex and involving sensitive subject matter
• Demonstrates ability to understand and interpret detailed policies and procedures and to be able to apply them to various situations. This includes thorough understanding of CBC’s responsibility to maintain privacy of Protected Health Information as required by the Health Insurance Portability and Accountability Act.
• Demonstrates ability to work independently, be flexible and react appropriately to changing job assignments and work environments.
• Demonstrates analytical, organizational, and problem solving skills in order to accurately and efficiently identify, analyze and respond to customer/provider inquiries, as well as identify and analyze trends and discrepancies.
• Familiar with, or ability to, operate a PC and associated software; Microsoft Word, Excel, etc., phone equipment, calculator, fax, copier, and other department required hardware.
• Demonstrated competency in Facets, Windows (Outlook, Word, Internet Explorer, Excel and PowerPoint), CVS Caremark, SharePoint, and SalesForce.
• Above average reading, writing and arithmetic skills required (reading/math comprehension)

Knowledge:

• Knowledge of benefit programs administered and/or supported by Capital BlueCross. Includes all medical lines of commercial group products, Medicare Advantage, Medicare Part D and Medicare Supplemental Programs, Dental, Vision, Chiropractic, Prescription Drug, Benefits Management, and Disease Management.
• Knowledge of the PBM and Facets health plan administration processing systems as well as online files for determining enrollment, billing, and benefits. Knowledge of benefits administration policies, customer billing processes, claims processing and general procedures.
• Knowledge of ERISA, Act 68, and BCBSA MTM,PPACA, HIPAA quality and timeliness guidelines and standards to ensure they are consistently met or exceeded
• Knowledge of Account Administration regulations, policies and procedures pertaining to Capital BlueCross and transfer of enrollment and billing information.
• Knowledge of multiple online inquiry systems and coding structures of files to interpret data used in responding to inquiries, emails and Sales Force cases.

Experience:

• A minimum of three years in sales, customer service, or sales services. Experience with customer interaction preferred.

Education and Certifications:

• High School degree and demonstrated work experience of no less than three years is required.

Work Environment:

Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions.!!Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.!!Working environment includes typical office conditions.!!Flexible schedules, including nights and weekends, based on business needs.!!Lively and fast paced.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work 37.5 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

Other:

• Positions may be based in more than one on site location
• Travel@@Some travel into the office on weekends may be required for training sessions and/or between buildings.

About Us

Capital Blue Cross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for over 80 years, Capital Blue Cross offers employees excellent pay, bonus opportunities, benefits, health and wellness incentives, opportunities for career advancement and community involvement, and work-life balance. In return, every member of our workforce plays an important part in something much bigger: working together and making a difference every day to improve the health and well-being of our members and the communities in which they live.