What are the responsibilities and job description for the Member Management Coord position at Horizon Blue Cross Blue Shield of New Jersey?
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary :
The COB (Coordination of Benefits) Member Management function will be solely accountable for maintaining COB files and specifically ensure member data is kept consistent, accurate and current for the enterprise.
- Load and maintenance of member COB files
- Perform outreach to members to obtain COB information (LOI-s, phone calls, written correspondence etc).
- Resolve COB customer inquiries received via phone, fax, mail, e-mail, UCSW(Universal Customer Service Workstation), NASCO worksheets etc. in accordance with prescribed departmental process.
- Review & investigate computer systems and / or reference materials to complete COB verification based on the nature of the inquiry (member information, enrollment, etc.).
- Handle and respond to written COB correspondence
- Accurately document customer inquiries and actions taken in accordance with departmental guidelines to ensure appropriate follow up.
- Identify & escalate COB trends and root cause analysis of COB issues / problems to management in a timely fashion.
- Retrieve & analyze COB reports and perform corrective actions as necessary.
- Deliver an excellent customer service experience while meeting quality, production & timeliness standards.
- Communicate COB corrective actions with vendors, groups, sales or brokers as necessary.
- May participate in hospital and physician workshops on COB.
- May perform COB testing during implementation / upgrade of claims / customer service systems.
- Perform other relevant tasks as assigned by management.
Education / Experience :
Knowledge :
Skills and Abilities :
Travel (If Applicable) :
Salary Range : 43,514 - $57,898
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to : education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes :
Comprehensive health benefits (Medical / Dental / Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Salary : $43,514 - $57,898
