Arkansas Blue Cross and Blue Shield

Customer Support

• Ensure final resolution of each customer inquiry in a timely and courteous manner while documenting detailed information relevant to the contact.
• Resolution may require system research and/or contacting experts in other areas of the company.
• Strives for the company goal of “first time resolution” whenever possible.
• Communicates in a clear and concise manner (whether orally or in writing) using business English, correct grammar, and precise vocabulary.
• Interacts directly with customers, which may include members, groups, and providers to resolve issues related to the products and services and health insurance plans.

Customer Service Representative I

Claims Specialist

• The Claims Specialist resolves medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner according to divisional standards of quality and productivity.
• Resolution may include additional investigation or communication in order to obtain necessary information to complete the claim.
• Outside issues such as peak filing season, systems down time, inclement weather, holidays, and absenteeism may directly affect the volume of work for each Specialist.

• Communicates in a clear and concise manner (whether orally or in writing) using business English, correct grammar, and precise vocabulary.
• Interacts directly with customers, which may include members, groups, and providers to resolve issues related to the products and services and health insurance plans.
• Always conducts him/herself in a positive and professional manner.
• Becomes an expert on benefits and eligibility for health insurance plans supported by multiple lines of business.

Customer Service Representative

Manager

• The RN Case Manager plays a critical role in optimizing patient care and resource utilization.
• Responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs.
• Focuses on quality patient outcomes and cost-effective healthcare delivery.