CareFirst Member Service Representative I in Washington, District Of Columbia
Resp & Qualifications
CareFirst, Inc., and its affiliated companies, generally referred to as CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region’s largest private sector health insurer, serving the healthcare needs of 3.5 million members in Maryland, the District of Columbia, and portions of northern Virginia. The Company offers a comprehensive portfolio of products and services to individuals and groups, as well as state and federal government sponsored plans. With a market share almost three times that of the closest competitor, the company commands 45 percent penetration across the region.
In July 2018, Brian D. Pieninck assumed the role of President and CEO after serving as the company’s COO of Strategic Business Units and IT Division. Under his leadership, the organization completed an extensive review of its operations and clinical programs, resulting in an expansive 3-year strategy to grow and diversify the company’s core business. Along with a 5-year vision to drive the transformation of the healthcare experience across the continuum of its members, partners, and communities, the company has placed a renewed and intentional focus on fostering a mission-based culture, which drives every decision the company makes. The organization employs over 5,600 full-time employees in Maryland, Northern Virginia, the District of Columbia, and West Virginia. CareFirst has earned multiple workplace awards recognizing its leadership in diversity and inclusion, wellness engagement, and creation of a supportive and equitable work environment for all employees.
At CareFirst, you are part of an inspired, collaborative team that is building the healthcare experience we want for our families and our future. Every day, we make a meaningful difference in the communities where we live and work.
We practice empathy, seek to understand, invest in inclusion, demand equity and nurture belonging every day for our employees and the communities we serve. We rely on the rich diversity of our employees’ experiences and backgrounds to achieve our mission. Every year we host a Week of Equity and Action where we deepen our investment and commitment to diversity, equity, and inclusion. During this week thousands of employees engage in workshops and volunteerism with the goal of bettering themselves and our community.
Women make up around 70% of CareFirst’s employee population, and over 50% identify as BIPOC (Black, Indigenous, and people of color).
We have 9 resource groups that connect employees over shared identities (LGBTQ, veteran status, race, etc.) and passions (climate change, healthy living, leadership development).
Employees are encouraged to give back and volunteer in their communities with their civic engagement hours.
As a not-for-profit, CareFirst regularly ranks among the most philanthropic organizations with $65 million invested in the community in 2020 to improve overall health, and increase the accessibility, affordability, safety, and quality of healthcare throughout its market area. The company’s employees consistently add to this impact by devoting thousands of volunteer hours to numerous community organizations and social causes. The company’s continued efforts to reinvest in community health care programs has repeatedly earned CareFirst regional accolades as a leading corporate philanthropist, including the No. 2 and No. 7 spots on the Baltimore Business Journal and Washington Business Journal’s 2019 list of top corporate givers, respectively.
The Member Service Representative I is proficient in routine benefits, claims, and general inquiries. They have a general knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry.
Answers member inquiries by clarifying desired information; researching, locating, and providing information. Resolves member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
Examines claims to identify key elements, and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures. Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments, and managed care processes.
Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other BCBS Plans. Learns the details of offering and administering various billing transactions, i.e. direct pay, credit card payment, and debit accounting through the policyholders checking account, and how to effectively interact with or advise clients, group administrators, brokers, or providers on problem resolution.
Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.
Education Level: High School Diploma or GED.
Experience: 1 year customer service, claims experience, Inbound Call Center Experience.
Experience performing duties that are detailed in nature, exposure to health care, health insurance, medical information, and direct service experience is preferred.
Knowledge, Skills and Abilities (KSAs)
Self-starter with strong organizational skills and planning skills.
Ability to maintain effective interpersonal relationships.
Ability to recognize, analyze, and solve a variety of problems.
Excellent communication skills both written and verbal.
Maintains quality customer services by following customer service practices; responding to customer inquiries.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department: IT & Business Support Contact Center
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship