Client Advocacy & Resolution Expert

Blue Cross And Blue Shield Of North Carolina Winston Salem , NC 27108

Posted 3 months ago

Additional Locations:

Winston-Salem - MP5660

Job Description

Responsible for a customer-facing, service relationship with group clients, maintaining a high level of group engagement around service delivery, issue resolution and healthcare initiatives unique to group clients. Takes a multi-faceted and creative approach in managing the overall service strategy for the client. Partners with the sales team to maintain compliance with contractual agreements, effective cost control measures, policies, procedures and workflows to resolve group service inquiries. Drive excellence in sales delivery and support by efficiently and effectively addressing needs and issue escalations expressed by HR benefits managers and other group representatives. Build sustainable relationships with HR benefits managers and producers/consultants by providing market-leading service and support experience.

  • Identifies, analyzes and resolves complex operational issues impacting employer groups. Intake, manage, track and resolve inquiries, issues, and escalations raised by client representatives, agents/consultants. Monitor channels for inquiry intake, documenting and managing client representative concerns.

  • Designs, develops and maintains the integrity of account service plans. Arranges and facilitates all meetings to review the account service plan and group specific issues.

  • Secures the service deliverables with the account and identifies task and expectations from the group and fulfills deliverables. Reviews the status of the deliverables with the group and sales team.

  • Escalate high-priority or high-risk issues to Client Success Lead as needed to determine and carry out resolution.

  • Develop relationships with groups to understand their corporate goals, processes, procedures and systems to provide support for the relationship with Blue Cross NC. Provides plan/benefit administration support to client. Administer and monitor group contract provisions, in conjunction with the group administrator to maintain compliance with contractual agreements. Addresses group customer concerns and non-compliance contract/administrative issues. Coordinates the required corrective action as identified via data and root cause analysis.

  • Maintains a collaborative relationship with sales. Reports issues to sales, performs research, identifies issues, and root cause and proposes solutions. Identifies the support area to manage the analysis for root cause issues, as needed. Partner with sales team and cross-organizational support staff to identify and execute solutions for group service requests. Develops and manages documentation that captures issues across the plan, dates for completion and other key deliverables.

  • Represents Blue Cross NC in critical service related customer meetings to address issues, or administrative inefficiencies. Participates in customer-facing sales meetings as requested by the sales team.

  • Delivers group specific reporting, including reporting related to service issues and network disruption, and assists with communication plans. Reviews service related reporting with clients.

  • Leverage historic client inquiry and issue data to actively identify future resolution, optimizing inquiry management and issue resolution

  • Identifies group level operational inefficiencies and collaborates with Sales team to create a strategy to address. Identify and document best practices, and communicate key client issue resolution experiences to suggest process, product delivery, and group service improvement opportunities.

  • Identifies opportunities to control segment and book of business administrative or medical expense and deploys action plans to accomplish specific expense reduction goals. Assists in the analysis of products, identifies any deficiencies and makes recommendations for improvement. Identifies trends with issues.

Hiring Requirements

  • Bachelor's degree

  • 3 years of experience in a customer service role to include direct external customer contact

  • If no degree - high school diploma, GED or other accredited equivalency and 5 years of experience in the health insurance field to include direct external customer contact.

  • Must be able to obtain a North Carolina Health and Life Insurance license within the 60 days of employment in this position.

  • Must possess and maintain a valid driver's license.

Hiring Preferences

  • Knowledge of institutional and ancillary pricing, health care finance, hospital and ancillary payments.

  • Public speaking and presentation skills

  • Demonstrated problem-solver with experience in managing key customer relationships and high-priority escalations. Experience in service stakeholder interactions including member and provider.

  • Proven project management skills, with background in effectively engaging stakeholders cross-functionally

  • Strong analytic skills, above average creativity, logical and problem solving abilities

  • Excellent oral and written communication skills, interpersonal skills, planning and organizational skills.

  • Ability to set priorities and adapt to constant change

  • Excellent organizational and time management skills

  • Superior negotiation skills with practical experience negotiating sensitive customer satisfaction issues is required

  • Ability to interface with personnel at all levels is essential

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Client Advocacy & Resolution Expert

Blue Cross And Blue Shield Of North Carolina