a. Responsible for delivering an excellent customer experience for member, provider and other stakeholder inquiries via telephone in a contact center environment, while adhering to a structured schedule and meeting quality, attendance and production standards. Strives to provide first call resolution and de-escalates calls, as necessary.
b. Apply customer engagement philosophies and personality-based resolution techniques to all interactions. Integrate Wellmark’s customer experience principles into day-to-day interactions. Anticipate customers’ needs to make it easy to do business with Wellmark.
c. Ensure information about Wellmark’s products and services is clearly communicated by responding accurately, promptly and professionally. Advocate value-based customer experience by handling calls relating to health benefits, claims payment, etc.
d. Develop and maintain positive relationships with members, providers and other stakeholders by using Wellmark-approved methodologies to understand, anticipate, and provide solutions to customer needs. Ensure customers understand their products, benefits, tools and how to use them.
e. Ensure customer records (i.e. claims, membership and/or billing) are processed and updated timely and accurately. Identify and utilize appropriate resources to resolve customer inquiries.
f. Responsible for the analysis and appropriate resolution(s) of claim-related inquiries and processing. Will research, interpret and educate the customer regarding the claim(s) and will then determine next steps required in order to accurately process claims and outstanding claims inquiries.
g. Develop and maintain a strong business acumen within Wellmark market segments/lines of business and group benefit designs.
h. Promote and educate on self-service tools appropriately and accurately. Facilitate and teach customers to use appropriate resources/ tools and how to access health care information to manage health care costs most effectively.
i. Engaged and participate in team meetings, chat, corporate meetings, etc.
j. Promptly follow up on all inquiries and document resolutions. Responsible for the accurate recording and documentation in Wellmark’s system. Will document the type of contact, reason for the inquiry, and other tracking codes, which ensures the sharing of the “customer experience,” members concerns, and trends to the rest of the company.
k. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
Please inform us if you meet the definition of a \"Covered DoD official\".
