Blue Cross Blue Shield of North Dakota

Customer Support

• The Associate Customer Advocate is responsible for assisting and educating members, providers, or customers on products and plans.
• This position researches, analyzes, and resolves all inquiries, promoting a favorable image of the Company by demonstrating shared business values to all who contact.
• In addition, this position will foster and preserve reputable relationships with all members, providers, or customers by providing accurate and timely information in response to all inquiries.
• Associate Customer Advocates work in a structured, fast-paced call center environment.
• They have a supportive team of trainers and leaders to guide them through a phased training and ensure they develop the skills to succeed in the health insurance industry.
• Provides assistance, service, and education to members, providers, or customers through various channels including telephone, internet, and written inquiries.
• Ensures accuracy and timeliness in responding to inquiries.
• Processes and resolves customer issues with varying complexities.
• Documents interactions and correspondence with members or providers in a clear and concise manner and ensures they are tracked appropriately so they are easily accessible.
• Applies intermediate computer-based skills to navigate multiple systems and internal resources to address inquiries and gather plan details for members or providers while maintaining timeliness standards and inventory levels.
• Maintains base knowledge of insurance terms and practices along with various company offered products.
• Address and resolve a range of issues, from routine to moderately complex, using established procedures and sound judgment.
• Demonstrate the ability to independently manage common problems while recognizing when to seek guidance more complex or unfamiliar situations.
• Maintain awareness of available resources and support channels to ensure timely and effective issue resolution.

Associate Customer Service Representative

Manager

• Responsible for reviewing cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources to establish the most effective treatment plan within the provisions of the policy.
• Screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.
• Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention.
• Develops, coordinates, and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan.
• Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member.
• Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.
• Collaborates in identifying appropriate alternatives to the present care and aiding with identified needs by collaborating with the member and member's health care team.
• Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.
• Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.
• Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.
• Collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member's care throughout the case management process.

Associate Customer Service Representative

Medical and Behavioral Case Manager, RN