Contact Representative

2 months ago

Washington, Washington, D.C., United States Office Of Personnel Management Full time
Answers incoming telephone calls, correspondence, and provides direct responses to specific inquiries regarding FEHB Programs.

These responsibilities require knowledge of the laws and regulations governing the Programs, specific plan provisions, and current information related to enrollment and to insurance administrative systems.

Assists in Group administrative tasks, such as filing, recordkeeping, and assembling information packets and briefing materials.
Tracks and processes workloads, such as disputed claims within the Groups that administer FEHB Program contracts.

Performs automation support activities, and public contact activities throughout the FEIO in Groups, including those that operate open seasons and support the contracting Groups, and those that administer Individual Benefits and Life Insurance contracts.

Responds in a personable and professional manner to customer inquiries received over the telephone.
Helps inquirers understand FEHB processes and procedures and the respective Program features.
Responds verbally over the telephone, and to written correspondence via e-mail and regular mail.

Questions range from routine to complex in nature and pertain to a variety of Program issues, especially enrollment, premium, coverage, and current Program policies.

Questions and correspondence may also relate to disputed claims processing, status and routine submissions.

Helps customers with routine requests for assistance requiring immediate action, such as getting an enrollee in touch with the agency officials who can process transactions on behalf of the customer.

Keeps other office employees and leadership aware of current troublesome situations with broad patterns of repetition or sensitivity.
Uses and participates in the re-engineering and improvement of office documentation and tracking systems.
Monitors and updates status information with respect to, e.g., case files, and correspondence related to such workloads.
Associates supporting documentation and correspondence (including priority correspondence) with existing cases and identifies and sorts out duplicate materials.
Enters appropriate status information into control / tracking systems.
Assists with workload distribution and assignment by classifying, assigning tracking numbers, and giving claim case files to Examiners.

Assures completeness of information received before assigning case to Claims Examiner, obtains reconsideration files and other information from health plans, follows up with health plans that do not timely supply requested information.

Assists in developing and maintaining databases, web pages, and other computer-related resources.
Reviews outgoing packages to assure that they are assembled properly and routed appropriately to obtain all necessary clearances.

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