Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for timely and accurate research, response, and resolution to telephone, written, on-line, and walk-in inquiries received from members, groups, agents, providers, other plans, and the general public. This position is responsible for meeting all corporate and association guidelines (MTM, Inter-Plan Program, etc.).

DIMENSIONS

N/S

NATURE AND SCOPE

• The incumbent must have a clear understanding of functions to be performed in the unit to support the team. Under the direction of the Manager, the incumbent:

• Accesses on-line systems as required to review, research, and respond to a medium to high volume of phone, written, on-line and walk-in inquiries on a daily basis.

• Demonstrates above average verbal and written communication skills while responding to our internal and external customers’ inquiries.

• Interprets benefits to resolve inquiries.

• Routes inquiries to appropriate departments and Plans, for decisions required to finalize resolution to the inquiry.

• Researches inquiries, claims and reports for potential adjustments.

• Reports to management any inconsistencies and possible solutions to problems identified through researching and resolving inquiries.

• Completes reports as required by the team.

• Meets established quality and quantity standards for the position.

• In a backup capacity, provides support to other areas.

PRINCIPAL ACCOUNTABILITIES

• Ensures inquiries are resolved in a timely, accurate and professional manner.

• Ensure all projects, reports and special assignments are completed accurately, timely and efficiently.

• Ensures information related to benefit or system changes are maintained.

• Ensures a professional line of communication is maintained with our internal and external customers.

• Executes job responsibilities while demonstrating a cooperative team effort to support departmental, divisional and corporate goals.

• Maintains routine and consistent attendance.

• Works overtime as scheduled by the manager.

PRE-REQUISITES

• High school graduate or equivalent.

• Typing skills of 30 wpm.

• Experience on a PC in Microsoft Windows or similar environment.

• One (1) year experience professional telephone communication skills as demonstrated through prior positions held.

• One (1) year experience in Customer Service as demonstrated through prior positions held.

• Above average verbal and written communication skills, as demonstrated through prior positions held.

• Experience in independently researching and resolving problems as demonstrated through prior positions held.

• Experience in operating office equipment/machines (i.e., copier, calculator, and facsimile).

• Experience with claims format and coding currently in use as demonstrated through prior positions held or training.

• Basic knowledge of medical terminology as demonstrated through prior positions held or training.

• One (1) year experience in claims processing , coding and/or billing meeting quality and quantity standards.

• Above average benefit interpretation skills as demonstrated through prior positions held or testing.

• Above average math skills as demonstrated through prior positions held.

• One (1) year BlueCard experience.

Note: This job description is intended to describe the general content and requirements of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, 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 )

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Req ID: J239784