Position Summary
Provide excellent customer service by resolving basic customer inquiries related to claims, benefits, enrollment, appeals, and member information. Handle inquiries via phone, email, mail, fax, or other channels while maintaining quality and efficiency standards.
Key Responsibilities
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Receive and respond to customer inquiries through multiple channels (phone, email, fax, mail).
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Gather necessary information (e.g., member ID, claim number, name) to handle inquiries effectively.
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Review computer systems and reference materials to verify information.
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Initiate investigations for claims, benefits, enrollment, appeals, or other inquiries as needed.
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Utilize available resources to resolve or redirect inquiries per departmental procedures.
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Accurately document all customer interactions and actions in accordance with quality standards.
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Follow up on unresolved issues promptly; escalate recurring issues or trends to management.
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Maintain professionalism and provide a positive customer service experience.
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Perform additional tasks as assigned by management.
Education & Experience
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High School Diploma or GED required.
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Some prior call center or customer service experience in the health insurance industry preferred.
Knowledge, Skills & Abilities
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Familiarity with medical terminology and billing codes preferred.
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Strong customer service skills, including managing and diffusing irate callers.
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Ability to work effectively in a high-pressure, fast-paced environment.
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PC and keyboarding proficiency.
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Strong verbal, written, and interpersonal communication skills.
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Investigative and analytical abilities to resolve inquiries.
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Effective multitasking, time management, flexibility, and adaptability.
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Ability to work collaboratively in a team environment.
Additional Information
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Applicants may be required to pass assessments to confirm minimum qualifications.
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Horizon offers a comprehensive benefits package including:
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Health coverage (Medical, Dental, Vision)
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Retirement plans
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Generous PTO
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Incentive programs
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Wellness programs
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Paid volunteer time off
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Tuition reimbursement
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Equal Opportunity Employer
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, veteran status, disability, or any other protected status under federal, state, or local law. Reasonable accommodations are provided as part of the recruiting and hiring process.