PREMERA. Applying innovation and strategy to create leading-edge health coverage and benefit solutions for our members. PREMERA’s culture promotes individual development, fosters innovation, and rewards success. We are creative, strategic thinkers who use our talents to fulfill our mission of creating peace of mind for our members. First established in 1933, the PREMERA family of health-care companies is headquartered in Washington and serves over 1.5 million members in several Western States. Our unique value proposition is built on a strong local presence and national capabilities. If you would like to apply your skills and experience to create health-care solutions, consider the following position: Job Summary: Provide timely, accurate, courteous, and concise responses to inquiries in person, by telephone, or by correspondence. Act as a liaison between the Marketing Department/brokers, group contacts, and special accounts to coordinate the resolution to inquiries with internal departments and provide contract and claims assistance. Interpret benefit information and assist and educate members regarding available benefit options. Research and investigate claims to assure appropriate adjudication to the various client contracts. Assist in the facilitation of continual process improvement within Operations via the resolution process. Analyze data for the identification of aberrant or incorrect billing practices. Contribute to the short- and long-term department/corporate service, membership and profitability goals by assisting in the implementation plans for new customers. Responsibilities: 1. Provide timely, accurate, courteous and concise responses to inquiries made by marketing personnel, brokers, benefit administration offices, group contacts, and subscribers with reference to contracts, benefit information, eligibility, and the adjudication of claims. Requests any missing information from the group or broker. Distributes enrollment materials to appropriate departments. 2. Educate members regarding benefits, assisting them in making informed decisions. - Present a positive, professional image to customers, peers, and employees. Identify appropriate Relative Value Schedule (RVS), Fee Schedule Rules, benefits, contracts, and administrative guidelines to determine proper claims adjudication, including the utilization of 'please pays,' itemizations and special check processes. - Represent PBC to groups along with account managers or brokers; participate in external client meetings as requested or is necessary. Meet and/or assist with Employers/Brokers/Groups externally (e.g. benefit fairs, question and answer sessions, face to face problem solving). Perform activities such as developing and ordering employee packets and completing special projects. Coordinate with Sales Executives and Account Executives to arrange for and, if directed, conduct employee meetings, benefit fairs, etc. Assists Operations Managers and Vice President with client demonstrations for existing or potential clients. - Make presentations and answer benefit/claims questions using all available resources. - Resolve claims investigation/review and adjustments in accordance to policy and within department standards. 3. Coordinate with other departments to answer questions, resolve problems and ensure that plan and department requirements are met. 4. Participate in department staff meetings, updating staff on new business and significant changes in existing business to include contract modifications, new benefits, and regulatory contract changes. 5. Assist customer service staff with unusual inquiries and unique accounts. Prepare comparison studies of all problem solution options. 6. Act as liaison to coordinate catastrophic cases between members and groups. Maintain accurate and complete records on all assigned groups, including contracts, correspondence and special cases. 7. Keep record of representative working on specific problems to assure claims are handled in a timely manner and/or coordinate with their team lead to assist them in resolving the claim as necessary. 8. Work with Marketing to recommend client specific solutions to needs or problems. 9. Interact with all areas of PBC to correct or enhance specific implementation activities as manifested by customer service issues, observed concerns, or communication from members, brokers and group contacts. 10. Assist sales executives and account managers with employee meetings or special benefit fairs. 11. Maintain current knowledge of PBC benefit contracts to assist sales executives and account managers in responding to group or broker questions. 12. Act as liaison with UAT and IT regarding system changes that affect special accounts and require user input, analysis or testing. 13. Responsible for overseeing the resolution to a group, customer service, or marketing inquiry; ensures that any potential system or process failure is reported and researched. Recommend improved procedures and guidelines. Work with procedure area to document and keep procedures up-to date and accurate. Distribute and train new procedures to team members 14. As needed, provide back up to the Technical Support Specialists and/or Team Leads by handling supervisor calls, answering questions for Customer Service Representatives, or other similar duties. Assist in established goals, measuring progress and correcting performance issues in the team. Provide back up for Sales Executives and Account Executives in their absence, by responding to brokers, agents, groups, and/or individuals regarding benefits, underwriting guidelines, multiple lines of business, and other miscellaneous information. Provide backup customer service support as needed. 15. Work closely with technical support staff and team leaders to ensure desired results 16. Identify trends and provide spot and team training as needed 17. Additional administrative duties including filing of prospect information, answering the phone, and assisting with walk-in customers. 18. Provide administrative support to Account Managers by coordinating all internal activities necessary to service accounts. 19. Maintain current knowledge of each assigned account and the benefit plans offered in order to back up Account Managers by responding to broker/group technical questions on funding, renewal questions, and questions on all product lines. 20. Assist with claims reprocessing projects by requesting HPIA reports. Complete special projects and perform other duties as assigned. Minimum Qualifications: 1. Two years PBC customer service experience or an equivalent combination of training and experience in a related field. 2. Demonstrated ability to be assertive, professional, flexible, resourceful, and compassionate in problem resolution. 3. Excellent written and verbal communication skills; strong telephone skills. 4. Ability to work independently and as an effective team member. 5. Ability to perform effectively in a multiple task environment. 6. PC skills to include experience with Word and Excel. 7. Ability to travel as needed; occasionally overnights. Additional Qualifications Preferred: 1. Three years related customer service and public contact experience. 2. Knowledge of, or experience in the health care industry. 3. Familiar with current lines of business and in-depth product knowledge. Proven understanding of other applicable department functions. 4. College degree.