[Remote] Member Support Rep, GP

Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey is a health solutions leader in New Jersey, dedicated to empowering members to achieve their best health. The Member Support Representative is responsible for resolving escalated member inquiries and ensuring a high-quality member service experience by coordinating with Call Center Operations. Responsibilities • Receive escalated member inquiries via phone, fax, mail, e-mail, online, social media, etc. Probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry. • Review computer systems and/or other reference materials to complete verification process and ensure all privacy protocols are met. • Initiate investigation process based on the nature of the inquiry (claim, member information, benefits, enrollment, appeals, authorization, etc.) and work with other areas within the organization to resolve the issue. • Accurately document member inquiries and actions taken in accordance with departmental quality guidelines to ensure appropriate follow up. • Follow up on unresolved issues within set timeframes. • Identify trends and begin root cause analysis of systemic issues/problems. Escalate trend information to management on a timely basis. • Perform outbound calls to ensure member satisfaction and review customer service tickets to review proper documentation and accuracy. • Responsible for updates on Primary Care Physician (PCP) changes and facilitating fulfilment of requests to comply with 504 requirements. • Conduct MLTSS member survey for feedback on case manager visits. Skills • Call center/customer service experience within the health insurance industry required. • Requires strong oral and written communication skills. • Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.) • Excellent customer service skills including the ability to manage and diffuse irate calls. • Ability to work in a high pressure, fast-paced environment. • Requires good presentation skills. • Requires Project Management Skills • Requires excellent interpersonal and organizational skills. • Requires good Investigative and analytical skills • Ability to multitask • Time management skills. • Flexibility and adaptability • Ability to work effectively within a team environment Education Requirements • High School Diploma/GED required. Benefits • Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement Company Overview • Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is Apply tot his job