Resolve all inbound telephone inquiries at all levels for SPS providers/BCBS plans for BlueCard Host, Home and Local claims and inquiries
Establish and maintain outbound schedule/relationship as needed with SPS provider to resolve SPS provider inquires. Initiate outbound calls with Blue Plans to resolve issues, obtain status and initiate the escalation process.
Complete BlueCard Host, Home and Local adjustments/key claims as needed to resolve the provider's/member's issues
Facilitate weekly calls with hospital executives that include detailed discussions regarding claims processing and status of outstanding issues. Prepare executive communications for coordination with BlueCard Executives
Perform analysis to determine root cause of issues and escalate to leadership as appropriate.
Resolve inquiries received by the BlueCard Executives and serve as a point of contact for Inventory Management issues with other BCBS Plans
Handle complex issues received from the BlueCard PCC (Inbound and Outbound), National Sales and Marketing, Network Operations, Critical Inquires or National Strategic Accounts and facilitate resolution with the Home /Host Plan.
3 years related work experience in BlueCard and Local lines of business including customer service, adjustments and held claim functions.
In-depth understanding of InterPlan Policy and Processing Guidelines
Advanced knowledge level Microsoft Office
Blue Cross Blue Shield Of Florida