Job Summary

Provides assistance, mentoring and resolution, in a non-supervisory capacity, 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 State of New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming.

Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
ADA
E1. Exhibits competency in all 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 all inquiries and services incoming and outbound calls and correspondence. •Considers all 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 via phone, personal contact (lobby walk-ins), email, online chat or in writing; utilizes Letter Reference Guide (LRG) templates as necessary. •Takes ownership of problems and establishes relationships with all customers through written, verbal correspondence or personal contact (lobby walk-ins), meeting all 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 all 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 all job duties efficiently, accurately and at an acceptable rate of performance.
N7. Performs related 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 current consecutive experience as a Service Representative and/or Service/Claims Representative at BC/BS of WNY, within 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 perform the job including satisfactory completion of all 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 Microsoft 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 reach consensus. 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 all its components for prolonged periods of time and for the majority of required tasks
* Vision Req: Close vision (clear vision at 20 inches or less)

Pay Rate:

The starting hourly rate for this position listed above is for new employees. This rate 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 rate is commensurate with their anniversary year and pay grade as per the CBA.

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. 

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