Company: Cambia Health
Posted on: May 4, 2021
Primary Job Purpose
Open to all applicants within: Oregon, Washington, Idaho and
The Customer Service Professional I role is a full-time remote
Position starts: Monday, June 14th
Position closes to new applicants: Thursday, May 20th
The Customer Service Professional I provides information, education
and assistance to members, providers, other insurance companies,
attorneys, agents/brokers or other customer representatives on
recorded phone lines regarding benefits, claims and eligibility.
They also provide excellent and caring services to all internal and
external members and providers.
The Customer Service Professional I is likely to be the primary
contact between the corporation and members and providers. The
manner in which a member or provider is treated during that contact
is critical to retaining our customers and to the overall success
of the corporation.
General Functions and Outcomes
- Successfully complete training period and meet dependability,
timeliness, accuracy, quantity, and quality standards as
established by department. Study, review and learn information,
procedures and techniques for responding to a variety of
- Communicate with a variety of subscribers, providers,
healthcare providers, agents/brokers, attorneys, group
administrators, other member representatives, internal staff and
the general public with inquiries regarding benefits, claim
payments and denials, eligibility, decisions, and other information
through a variety of media - oral, written and on-line
communications. Respond to multiple inquiries on all designated
lines of business.
- Quickly and accurately assess provider and member inquiries and
requirements by establishing a rapport inquirer in order to
understand his/her service needs. Identify errors promptly and
determine what corrective steps may be taken to resolve
- Apply benefits according to appropriate contract. Determine
benefit payments, maximum allowable fees, co-pays, and deductibles
from appropriate contracts.
- Make appropriate corrections of denied, process-in-error or
- Explain benefits, rules of eligibility and claims payment
procedures, pre-authorizations, medical review and referrals, and
grievance/appeal procedures to members and providers to ensure that
benefits, policies and procedures are understood.
- Educate members and providers on confusing terminology and
policies such as eligible medical expenses, hold harmless, medical
necessity, contract exclusions and limitations, and managed care
- Maintain confidentiality and sensitivity in all aspects of
internal and external contacts.
- Manage high volume of calls on a daily basis, prioritize
follow-through and document member and provider inquiries and
actions on tracking system and/or by completing logs. May generate
written correspondence and process document requests.
- Maintain files/records of constantly changing information
regarding benefits/internal processes including company-wide
internal policies and benefit updates for new or existing business.
Work is subject to audit/checks and requires considerable accuracy,
attention to detail and follow-through.
- Comply with NMIS/MTM and Consortium standards as they relate to
the employee's responsibility to meet BlueCross BlueShield
Association (BCBSA) standards and corporate goals.
- Assist in identifying issues and trends to improve overall
- For HMO related work: Enter, correct and adjust referrals
according to established policies and procedures. Explain referral
rules, processes to providers and internal customers. Minimum
- Keyboarding skills of 30 wpm with 95% accuracy.
- Proficient PC skills and prior experience in a PC
- Demonstrated knowledge of medical terminology and coding
- Ability to apply mathematical concepts and calculations.
- Ability to communicate effectively orally and in writing with
understanding and ability to apply correct punctuation, spelling,
grammar and proof-reading skills.
- Demonstrated ability of strong customer-service skills,
including courteous telephone etiquette.
- Ability to make decisions and exercise good judgment in a
complex and rapidly changing environment.
- Ability to adapt to a fast-paced environment and learn, retain,
and interpret new or evolving information, procedures, and policies
and communicate them effectively.
- Ability to work under stress and pressure and respond to
inquiries with tact, diplomacy and patience.
- Ability to work in a team environment.
- Ability to exercise discretion on sensitive and confidential
- Demonstrate initiative in researching and resolving benefit,
and eligibility issues.
- Our call centers are open 5am-8pm (PST) M-F and 8am to 4:30 pm
(PST) on Saturdays. You may be asked to work a schedule on
Saturdays or until 8pm during the week.
- This is a full-time and permanent remote position Pay will be
discussed when recruiter reaches out
Normally to be proficient in the competencies listed above
Customer Service Professional I would have a high school diploma or
equivalent and 6 months of customer service call center experience
or 6 months of customer service experience such as insurance,
retail, banking, restaurant, hospital medical office or other
experience with extensive customer service contact or equivalent
combination or education and experience.
- This is a permanent remote position
- May be required to work overtime.
- May be required to work outside normal hours.
We are an Equal Opportunity and Affirmative Action employer
dedicated to workforce diversity and a drug and tobacco-free
workplace. All qualified applicants will receive consideration for
employment without regard to race, color, national origin,
religion, age, sex, sexual orientation, gender identity,
disability, protected veteran status or any other status protected
by law. A drug screen and background check are required.
If you need accommodation for any part of the application process
because of a medical condition or disability, please email .
Information about how Cambia Health Solutions collects, uses, and
discloses information is available in our .
Keywords: Cambia Health, Salem , Customer Service, Hospitality & Tourism , Salem, Oregon
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