[Hiring] Medicare Advantage Specialist @Blue Cross Blue Shield of Nebraska

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role is responsible for providing support, quality reviews, coaching and training to customer service representatives assigned to the Medicare Advantage program. • Serve as a helpline for customer service representatives to answer questions and provide guidance on Medicare Advantage inquiries. • Address complex customer issues and escalate, as necessary, to ensure timely resolution. • Develop and implement training programs for customer service representatives focused on Medicare Advantage policies, procedures, and compliance requirements. • Provide ongoing coaching and support to service representatives to enhance their knowledge and performance in handling Medicare Advantage-related inquiries. • Monitor and evaluate customer interactions to ensure adherence to Medicare Advantage standards and regulations. • Conduct audits and quality assessments to identify areas for improvement and implement corrective actions, as needed. • Receive and investigate Medicare Advantage grievances from customers and internal stakeholders. • Ensure grievances are documented, reviewed, and resolved in accordance with CMS guidelines and timelines. • Prepare and submit reports to CMS detailing grievances and resolution actions taken. Qualifications • Bachelor’s degree in healthcare administration is preferred. • Minimum of 1-2 years of experience working in Medicare Advantage, healthcare compliance, or related area is required. • Strong understanding of Medicare Advantage policies, regulations, and reporting requirements. • Excellent communication and interpersonal skills, with the ability to effectively train and coach others. • Detail-oriented with strong analytical and problem-solving abilities. • An equivalent combination of education and experience may be substituted for this requirement. • The ability to meet or exceed the attendance and timeliness requirements of their departments. • The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers. Requirements • Proficient in Microsoft Office applications and experience with healthcare management software is a plus. Company Description At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. We have more than 80 years of experience behind us. And a bright future ahead as we continuously innovate to drive health care forward while meeting the needs of our members and state. Apply tot his job