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- Successfully progress through and complete on-the-job training to respond verbally, in person and in writing to internal and external customer's inquiries on enrollment, eligibility, benefits and claims adjudication questions in a professional, accurate and timely manner.
- Review, assess and deliver accurate and timely responses to eligibility, benefit and basic claims status inquiries using multiple systems and resources to research information (i.e., QNXT, Documentum, 837 Database, Mainframe, ASSIST, FEPDirect, FEPBlue.org, BlueWeb.org, PC software).
- Effectively apply reasoning and problem solving and successfully complete interactions with internal and external customers to achieve high quality customer-centric delivery of service. This will include:
- Efficiently and comprehensively identify the inquirer's reason for contacting us. Adapt our response delivery to address all issues in a positive and helpful manner providing information and education of clarifying concepts when necessary. Share our internal expertise of the benefit and processes to resolve Member and Provider inquiries.
- Apply sound decision making to request and compile appropriate supporting documentation as required by the FEP Director's Office or the FEP Operations Center to update, correct or initiate member enrollment or demographic information, plan primacy order, servicing authorization, TPL case pursuit, and other documentation as needed.
- Collaborate with internal departments that support FEP benefit and claims processing activities such as Medical Management, Customer Relations and Finance & Accounting to ensure consistent delivery of information and services.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
Qualifications
- High school diploma or GED and eighteen months of work experience or an equivalent combination of education, and experience.
- Effective verbal and written communication skills.
- Requires attention to detail and the ability to work on multiple projects simultaneously.
- Working knowledge of general office practices and procedures.
- Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
- Must complete the FEP training examination with a score of no less than 90% within one (1) year of hire.
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