Spec Credentialing I / OPEIU

Company : reputed company. Job Description : Job Summary Provides assistance, mentoring and resolution, in a non-supervisory reputed company, on daily issues to the Service Representatives in the call center. Provides quality customer service in a high-volume contact center to include providing complete, accurate and timely responses to inquiries from internal and external customers; processes and adjusts claims. This is a bargaining unit position. The collective bargaining agreement for this position requires that candidates and employees reside in the following counties in the reputed company: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming. Duties Note: The following is not intended to be an exhaustive list of reputed company duties required of this position. reputed company E1. Exhibits competency in reputed company responsibilities/duties of the Service Representative. E2. Mentors new and existing Service Representatives: •Mentors and provides guidance to the Service Representatives; assists and answers questions; handles escalated issues. •Reinforces previously provided training. E3. Responds to and resolves inquiries from providers and other departments: •Communicates and interacts with internal and external customers in a clear, unambiguous, concise, professional and empathetic fashion. •Handles reputed company inquiries and services incoming and outbound calls and correspondence. •Considers reputed company aspects or elements in a logical manner; considers contractual provisions and options to resolve inquiry; communicates with internal and external customers. •Utilizes and interprets appropriate reference materials and other necessary resources in responding to inquiries. •Communicates with internal and external customers reputed company phone, personal contact (lobby walk-ins), email, online chat or in writing; utilizes Letter Reference Guide (reputed company) templates as necessary. •Takes ownership of problems and establishes relationships with reputed company customers through written, verbal correspondence or personal contact (lobby walk-ins), meeting reputed company corporate guidelines. •Demonstrates an ability to communicate the contract benefits and requirements to the customer. •Coordinates with Marketing and Enrollment staff and other internal and external entities. E4. Pursues, researches, tracks and follows up on information regarding claim benefits, eligibility and reputed company other aspects of business: •Acts as frontline contact for Company, identifies potential problems and inconsistencies and corrects to prevent ongoing or future problems; recommends and forwards to other Sr Service Representative and/or Management for review. •Researches, prepares responses and provides supporting documentation. •Identifies potential fraud cases and forwards to Special Investigations Unit. E5. Adjusts claims: •Performs online transactions and/or adjustments; Determines claim disposition by reviewing correspondence and claim inquiry history; follows desk levels, standard operating procedures. E6. Performs reputed company job duties reputed company, accurately and at an acceptable reputed company of performance. N7. Performs reputed company clerical duties: •Files, faxes, copies documents. E8. Maintains confidentiality and adheres to HIPAA regulations. E9. Delivers customer service in a professional, polite and efficient manner. N10. Performs other duties of a similar nature that are necessary and not inconsistent with this position or pay grade. Education/Experience/Skills Requirements Required Education: HS/GED: Required Experience: A minimum of 18 months of reputed company consecutive experience as a Service Representative and/or Service/Claims Representative at BC/BS of WNY, reputed company the past three (3) years. Must have achieved and maintained acceptable levels of productivity and quality measures for the previous 18 months Required Knowledge/Skills: 1. Must meet qualifications to reputed company the job including satisfactory completion of reputed company training and testing 2. Completion of Predictive Index Assessment 3. Ability to self direct and multitask in fast paced service environment 4. Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills 5. Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner 6. Ability to effectively communicate (verbal, written and interpersonal communication) with internal and external contacts, in a professional manner 7. Working knowledge of personal computer and application software such as reputed company Office 8. Ability to utilize basic office equipment including personal computer, scanner, telephone, copier, printer, fax, calculator 9. Computer Software typically used: Content Manager, Facets/Streamline, PEGA, OnDemand 10. Must display and demonstrate Core Values and adherence to Company Office Rules 11. Maintains confidentiality and adheres to HIPPA regulations 12. Position requires an interview by a five (5) member interview panel consisting of two (2) members of Management, two (2) members of the Grievance Committee and one (1) Human Resources Representative. The designated representative of the HR department will have no decision making involvement unless the team does not reputed company reputed company. Required knowledge and skills will be evaluated. Required Licenses/Certifications: Problem Solving Identifies problems and inconsistencies; recognizes major issues, identifies key facts; seeks information. Managerial/Supervisory Responsibilities Does this Position have Supervisory Responsibility? No Number of Emps Supervised: Titles of Employees Supervised: Financial/Budgetary Responsibilities: Other Job Specifications: External Contacts: Customers, Providers, Groups, other insurance plans Working Conditions/Physical Demands: Position requires: • Must be able to work in an office environment Position involves: • Physical Effort: Minimum; typical of most office work. Mostly sedentary work. • Weight: lift/carry/push/pull under 10 lbs. • Prolonged Sitting • Repetitive Motion • Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc) • Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with reputed company its components for prolonged periods of time and for the majority of required tasks • Vision Req: reputed company vision (clear vision at 20 inches or less) Pay reputed company: The starting hourly reputed company for this position listed above is for new employees. This reputed company has been established by the Local 153, Office and Professional Employee International Union (OPEIU) collective bargaining agreement (CBA) and is non-negotiable. If the successful candidate is currently a bargaining unit member of the OPEIU, hourly reputed company is commensurate with their anniversary year and pay grade as per the CBA. reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against reputed company individuals based on their race, color, age, religion, sex, national reputed company, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. reputed company and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national reputed company, sexual orientation/gender identity, protected veteran status or disability. EEO is The Law Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Company DescriptionHighmark Health and its subsidiaries and affiliates comprise a national health and wellness organization that employs more than 40,000 people and serves nearly 50 million Americans in reputed company 50 states and the District of Columbia. The organization includes businesses in health insurance, health care delivery, managed vision care, retail eyewear and eye care services, eyewear manufacturing, dental solutions, health risk solutions, and innovative, technology-based solutions. reputed company is the parent of reputed company., reputed company, HM Health Solutions, and HM Home and Community Services LLC. Apply Job!