Hics Customer Care Representative

1 week ago

Phoenix, United States Blue Cross Blue Shield of Arizona Full time

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

PURPOSE OF THE JOB

This is a highly specialized customer service position focused on the resolution of complaints for individuals and families enrolled with Marketplace coverage. The position requires unique knowledge of the Federally-facilitated Exchange (FFM) regulatory requirements necessary to research, process, and resolve FFM complaint referrals received from Health and Human Services (HHS) through the Health Insurance Casework System (HICS). Responsibilities require intensive research, analysis and strong communication via telephone and written correspondence with members, internal shared services partners, vendor enrollment/billing processors, and CMS Marketplace representatives.

Additionally, this role supports research and reconciliation projects for the ACA Program Integrity, as needed. CMS online systems access certification must

be obtained.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience
- 1 year experience in health insurance operations role
- 1 year working with FFM and/or BCBSAZ benefit plans

2. Required Education
- High-School Diploma or GED in general field of study

3. Required Licenses
- N/A

4. Required Certifications
- Access certification/approval through CMS is necessary to access government systems required for the role

PREFERRED QUALIFICATIONS

1. Preferred Work Experience
- 2 year(s) of experience in health insurance operations role
- 2 years working with FFM enrollment processing

2. Preferred Education
- Associate's Degree in general field of study

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Retrieve Level 1 and Level 2 HICS complaints from the CMS Health Insurance Casework System.
- Load appropriate case files to enrollment vendor systems for tracking and conduct an initial review of Level 1 and Level 2 HICS complaints, prioritizing casework by CMS timeliness standards.
- Conduct in-depth research, utilizing CMS System of Exchange Enrollment Data (SEED), various health plan systems, and communication with internal BCBSAZ teams.
- Proactively consult and coordinate with various internal departments, vendor partners, and CMS Marketplace representatives to resolve customer complaints with accurate, compliant, customer-focused responses.
- Identify, coordinate, and monitor completion of enrollment and billing transactions required to resolve complaints.
- Accurately respond to member questions regarding plans and benefits information, as well as other organization services, including automatic payment setup, in-network provider status, wellness incentives, etc.
- Finalize accurate written member correspondence clearly indicating the outcome of the HICS complaint.
- Document factual case notes for all HICS cases and each customer interaction in various systems, including but not limited to Salesforce, GetNext and HICS, in accordance with CMS and department quality standards.
- Meet quality, quantity, and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
- Demonstrate and maintain current working knowledge of Federally-facilitated Enrollment (FFM) regulations related to HICS Best Practices, and the required BCBSAZ systems, procedures, forms, and manuals.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills
- Intermediate skill in the use of computers, Microsoft Office suite, internet browsers, teleconferencing platforms, telephone, and other relevant technology

2. Required Professional Competencies
- Every interaction is handled with the utmost care, consideration, and passion for the members we serve.
- Maintain confidentiality and privacy
- Practice interpersonal and active listening to achieve high customer satisfaction
- Compose a variety of business correspondence
- Interpret and translate policies, procedures, programs and guidelines
- Capable of investigative and analytical research
- Follow and accept instruction and direction
- Establish and maintain working relationships in a collaborative team environment
- Prioritize, organize and self-manage workload to meet compliance

3. Required Leadership Experience and Competencies
- N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills
- Advanced knowledge of enrollment transactions that support FFM reconciliation processes
- Intermediate knowledge of insurance claim coding
- Intermediate understanding of medical terminology &

  • Customer Care Representative

    2 weeks ago

    Phoenix, United States Kelly Services Full time

    Job DescriptionJob DescriptionJob searching is a lot better with someone in your corner. Hi—enter us, and this job! Kelly® Professional & Industrial is seeking a Remote Customer Care Representative to work at a premier pet insurance company in Phoenix, AZ. Sound like something you’re interested in? We’ll be here every step of the way to help you...

  • Customer Care Representative

    4 weeks ago

    Phoenix, United States NTT Data Services, Inc. Full time

    **Customer Care Representative, Healthcare** - Will go onsite first day to pick up equipment. - Monday to Friday 8am to 5pm. Training will be virtual 8am to 5pm for 3 weeks TT DATA Services currently seeks Care Management Associates (Call Center) to join our team working in Phoenix, AZ. - Coordinates care with providers as a part of comprehensive and...

  • Customer Care Representative

    13 hours ago

    Phoenix, United States NTT Data Services, Inc. Full time

    **Customer Care Representative, Healthcare** - Will go onsite first day to pick up equipment. - Monday to Friday 8am to 5pm. Training will be virtual 8am to 5pm for 3 weeks TT DATA Services currently seeks Care Management Associates (Call Center) to join our team working in Phoenix, AZ. - Coordinates care with providers as a part of comprehensive and...

  • Customer Care Representative

    3 weeks ago

    Phoenix, Arizona, United States Motion Recruitment Full time

    Come join our team. Our client is looking for a Customer Care Representative for a 6-month contract in Phoenix, AZ 85040.Our client is a global, values-driven corporation that leads the communications, automotive, and media industries. Apply today to be on a team that disrupts industries and builds a better future for the next generation.Contract Duration: 6...

  • Customer Care Representative

    1 month ago

    Phoenix, Arizona, United States Motion Recruitment Full time

    Come join our team. Our client is looking for a Customer Care Representative for a 6-month contract in Phoenix, AZ 85040.Our client is a global, values-driven corporation that leads the communications, automotive, and media industries. Apply today to be on a team that disrupts industries and builds a better future for the next generation.Contract Duration: 6...

  • Parts Customer Care Representative

    6 days ago

    Phoenix, Arizona, United States Crown Equipment Full time

    Answer and process incoming parts calls from customers and service technicians. Pull orders, receive and put up stock. Order parts and develop relationships with Crown factory and outside vendors. Enhance customer retention by monitoring customer sat Customer Care, Representative, Parts, Inventory Control, Customer, Manufacturing, Retail

  • Customer Care Representative

    1 month ago

    Phoenix, United States Landsea Homes Full time

    Job DescriptionJob DescriptionPosition Summary:Landsea Homes is seeking an intelligent and highly organized individual interested in a fast-paced and challenging position as a Customer Care Representative. This position reports to the Director of Customer Care and will play a vital role in ensuring Landsea Homes’ Customer Care Department provides an...

  • Customer Care Representative

    3 weeks ago

    Phoenix, United States Landsea Homes Full time

    Job DescriptionJob DescriptionPosition Summary:Landsea Homes is seeking an intelligent and highly organized individual interested in a fast-paced and challenging position as a Customer Care Representative. This position reports to the Director of Customer Care and will play a vital role in ensuring Landsea Homes’ Customer Care Department provides an...

  • Parts Customer Care Representative

    3 weeks ago

    Phoenix, United States Crown Equipment Full time

    Parts Customer Care Representative Location: Phoenix, AZ, US, 85338 **Company Description:** Crown Equipment Corporation, one of the world's largest lift truck manufacturers, offers local support on a global scale with more than 15 manufacturing facilities worldwide and more than 500 retail locations in over 80 countries. Our global sales and service network...

  • Service Customer Care Representative

    4 weeks ago

    Phoenix, United States Crown Equipment Full time

    Service Customer Care Representative Location: Phoenix, AZ, US, 85338 **Company Description:** Crown Equipment Corporation, one of the world's largest lift truck manufacturers, offers local support on a global scale with more than 15 manufacturing facilities worldwide and more than 500 retail locations in over 80 countries. Our global sales and service...

  • Service Customer Care Representative

    2 days ago

    Phoenix, United States Crown Equipment Full time

    Service Customer Care Representative Location: Phoenix, AZ, US, 85338 **Company Description:** Crown Equipment Corporation, one of the world's largest lift truck manufacturers, offers local support on a global scale with more than 15 manufacturing facilities worldwide and more than 500 retail locations in over 80 countries. Our global sales and service...

  • Customer Care Representative

    3 weeks ago

    Phoenix, United States Terumo Medical Corporation Full time

    Job Summary: Customer Care Representative II (CCRII) strives to provide the absolute best customer experience daily. Responsible for order entry and managing all customer requests about product orders, returns, or general inquiries with a focus on customer satisfaction. .CCRII works in a fast-paced team environment to support Terumo’s businesses. While...

  • Customer Care Representative

    4 weeks ago

    Phoenix, United States Terumo Medical Corporation Full time

    Job Summary: Customer Care Representative II (CCRII) strives to provide the absolute best customer experience daily. Responsible for order entry and managing all customer requests about product orders, returns, or general inquiries with a focus on customer satisfaction. .CCRII works in a fast-paced team environment to support Terumo’s businesses. While...

  • Customer Care Representative

    4 weeks ago

    Phoenix, United States Terumo Medical Corporation Full time

    Job Summary: Customer Care Representative II (CCRII) strives to provide the absolute best customer experience daily. Responsible for order entry and managing all customer requests about product orders, returns, or general inquiries with a focus on customer satisfaction. .CCRII works in a fast-paced team environment to support Terumo’s businesses. While...

  • Customer Care Representative

    3 weeks ago

    Phoenix, United States Terumo Medical Corporation Full time

    Job Summary: Customer Care Representative II (CCRII) strives to provide the absolute best customer experience daily. Responsible for order entry and managing all customer requests about product orders, returns, or general inquiries with a focus on customer satisfaction. .CCRII works in a fast-paced team environment to support Terumo’s businesses. While...

  • A1 Customer Care Representative

    6 days ago

    Phoenix, Arizona, United States A1 Garage Door Service Full time

    Job Type Full-time Description Customer Care Representative Pay: $17.50 an hour Full-Time (40hrs), Monday - Friday Location: Remote Primary Purpose: To be successful in this role, you will need to be organized, efficient, persuasive and have practical problem-solving skills. You will be interacting with our customers daily and having patient and respectful...

  • Client Senior Representative, Customer Care

    7 days ago

    Phoenix, United States Sunrise Systems Full time

    Job title : Client Senior Representative, Customer Care Job ID: - Location: Phoenix, AZ Duration: months; with possible extensions Work remotely from home, with the occasional request for you to commute to our nearest office for in person engagement activities such as team meetings, training and culture events. MUST HAVE: Active Property & Casualty...

  • Parts Customer Care Representative

    1 week ago

    Phoenix, United States Crown Equipment Corporation Full time

    **Company Description**: Crown Equipment Corporation, one of the world's largest lift truck manufacturers, offers local support on a global scale with more than 15 manufacturing facilities worldwide and more than 500 retail locations in over 80 countries. Our global sales and service network provides our customers with a local resource for a wide variety of...

  • Service Customer Care Representative

    1 week ago

    Phoenix, United States Crown Equipment Corporation Full time

    **Company Description**: Crown Equipment Corporation, one of the world's largest lift truck manufacturers, offers local support on a global scale with more than 15 manufacturing facilities worldwide and more than 500 retail locations in over 80 countries. Our global sales and service network provides our customers with a local resource for a wide variety of...

  • Customer Sales Representative

    3 weeks ago

    Phoenix, United States LMC Phoenix, Inc. Full time

    Job DescriptionJob DescriptionCustomer Sales Representative This is an in-person position, we do not offer remote at this time.We are searching for a person who cares about the quality of products and services they represent, their customers, and their co-workers. As an Entry Level Sales Representative, your main goals will be to retain customers, increase...