Job Description
Position Description:
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The Member / Provider Services Representatives ("MSRs" / "PSRs") are the front-line team at Capital BlueCross ("CBC") and are responsible for handling all customer inquiries through multiple channels (i.e., phone, web, electronic, and/or face-to-face) by using resources, materials and tools with accuracy and precision. This incumbent will be responsible for effectively presenting and discussing our products and services, creating and maintaining positive relationships and for exceeding quality, productivity, and ultimate performance goals. This incumbent will be required to initially attend an extensive training class in addition to ongoing periodic refresher trainings to service our customers (i.e. members/providers/group leaders) as business needs permit.
Responsibilities and Qualifications:
Member-Focus:
Manage telephone, electronic, and face-to-face interactions professionally, efficiently and with excellent communication skills
Effectively present and discuss the products and services to external and internal customers with integrity and understanding and accuracy with every interaction
Focus on customer retention through first call resolution of concerns and enhancement of the member experience
Establish and maintain positive relationships with customers on behalf of the company by taking personal and complete responsibility for each customer interaction
Ensure all customers' needs are completely met, timely, without elevation if possible
If business needs permit, support the efforts of CBC sales representatives by conducting onsite and/or community-based educational meetings
Performance standards, business metrics and process improvements:
Large emphasis on quality, productivity, adherence to schedules, handle time, and not negatively affective and jeopardizing CBC customer relations, internally and externally
Adaptability to use of soft skills and call strategies.
Complete ongoing training to stay abreast of products, services and policy changes
Improve quality of work on a daily basis by learning and employing new skills or adapting previous processes to mirror the fit-for-excellence company culture
Recognize, document, and alert supervisors of trends in customer calls
Conduct self in a manner consistent with the values of the organization
Skills:
Must possess basic reading and arithmetic skills (reading and math comprehension).
Must possess above average verbal and written communication skills.
Average or above average social and emotional intelligence candidates preferred.
Demonstrated competency in computer programs such as internet browsers, Microsoft Outlook, Word, Excel, PowerPoint, etc.
Must be able to build and/or retain excellent customer relationships by presenting a positive and cooperative attitude via multi-channel connections with customers
Ability to deliver 'delightful' and effective customer service to enhance the member experience and build customer satisfaction and loyalty with both internal and external customers
Ability to actively listen paired with the ability to demonstrate empathy for customers
Be service and solution oriented by actively looking for ways to help
Be patient, stress tolerant and show empathy to customers, both internal and external
Must possess a strong attention to detail and an interest in preventing errors
Demonstrate critical thinking, problem solving, and decision making abilities
Demonstrate effective communication skills both verbal and written
Ability to critically observe, analyze, think creatively, research and resolve customer complaints
Demonstrate ability to be independent, resourceful, self-sufficient, dependable and professional
Demonstrate intrinsic initiative, time management,
Ability to effectively de-escalate upset callers with minimal supervisory intervention
Demonstrate ability to collaborate with others and work as a member of a team
Ability to thrive in a dynamic working environment, multi-task, and adapt quickly
Ability to accept feedback, learn, and adapt from guidance to be successful
Ability to mentor peer group in best practice standards as well as positively spread continuous changes to processes and the responsive health care environment
Have a strong work ethic, passion for our products and our customers' experiences
Foster an inclusive culture of diversity, working well with others
Must be able to meet quality, productivity, and behavior expectations
Knowledge:
Knowledge of company and products in order to up-sell and speak highly of our products and company
Experience:
1 year of customer service experience.
Ability to mentor peer group in best practice standards as well as positively spread continuous changes to processes and the responsive health care environment
Have the capacity to up-sell and speak highly of our products and company
Have a strong work ethic, passion for our products and our customers' experiences
Foster an inclusive culture of diversity, working well with others
Must be able to meet quality, productivity, and behavior expectations
Recent tele-commuting experience a plus
Education and Certifications:
Must have a High School Diploma or GED
College degree or professional certification (Medical Assistant, Certified Professional Coder, Pharmacy Technician) a plus
Bi-lingual (Spanish) a plus
License to sell (a plus, may be required for advanced positions)
Work Environment-Call Center environment
Qualified candidate must be flexible to work any varied shift schedules that may span anywhere between 8:00 a.m. to 8:00 p.m., any day of the week
Minimum Internet Service Provider (ISP) speed requirements for work at home: Approximately 15Mbps download and 5Mbps upload per person working at the remote site (home). Latency (PING) under 150ms Satellite internet is typically not sufficient for real-time communication with tools that support voice or video
Physical Demands:
While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds
Other:
Key Interfaces:
Salesforce
Facets
Bridges
Workflow
Microsoft Office (Outlook, Word, Excel, PowerPoint)
Availity
NICE InContact
Workbench
Prime RxClaims
TruCare
About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The Member / Provider Services Representatives ("MSRs" / "PSRs") are the front-line team at Capital BlueCross ("CBC") and are responsible for handling all customer inquiries through multiple channels (i.e., phone, web, electronic, and/or face-to-face) by using resources, materials and tools with accuracy and precision. This incumbent will be responsible for effectively presenting and discussing our products and services, creating and maintaining positive relationships and for exceeding quality, productivity, and ultimate performance goals. This incumbent will be required to initially attend an extensive training class in addition to ongoing periodic refresher trainings to service our customers (i.e. members/providers/group leaders) as business needs permit.
Responsibilities and Qualifications:
Member-Focus:
Manage telephone, electronic, and face-to-face interactions professionally, efficiently and with excellent communication skills
Effectively present and discuss the products and services to external and internal customers with integrity and understanding and accuracy with every interaction
Focus on customer retention through first call resolution of concerns and enhancement of the member experience
Establish and maintain positive relationships with customers on behalf of the company by taking personal and complete responsibility for each customer interaction
Ensure all customers' needs are completely met, timely, without elevation if possible
If business needs permit, support the efforts of CBC sales representatives by conducting onsite and/or community-based educational meetings
Performance standards, business metrics and process improvements:
Large emphasis on quality, productivity, adherence to schedules, handle time, and not negatively affective and jeopardizing CBC customer relations, internally and externally
Adaptability to use of soft skills and call strategies.
Complete ongoing training to stay abreast of products, services and policy changes
Improve quality of work on a daily basis by learning and employing new skills or adapting previous processes to mirror the fit-for-excellence company culture
Recognize, document, and alert supervisors of trends in customer calls
Conduct self in a manner consistent with the values of the organization
Skills:
Must possess basic reading and arithmetic skills (reading and math comprehension).
Must possess above average verbal and written communication skills.
Average or above average social and emotional intelligence candidates preferred.
Demonstrated competency in computer programs such as internet browsers, Microsoft Outlook, Word, Excel, PowerPoint, etc.
Must be able to build and/or retain excellent customer relationships by presenting a positive and cooperative attitude via multi-channel connections with customers
Ability to deliver 'delightful' and effective customer service to enhance the member experience and build customer satisfaction and loyalty with both internal and external customers
Ability to actively listen paired with the ability to demonstrate empathy for customers
Be service and solution oriented by actively looking for ways to help
Be patient, stress tolerant and show empathy to customers, both internal and external
Must possess a strong attention to detail and an interest in preventing errors
Demonstrate critical thinking, problem solving, and decision making abilities
Demonstrate effective communication skills both verbal and written
Ability to critically observe, analyze, think creatively, research and resolve customer complaints
Demonstrate ability to be independent, resourceful, self-sufficient, dependable and professional
Demonstrate intrinsic initiative, time management,
Ability to effectively de-escalate upset callers with minimal supervisory intervention
Demonstrate ability to collaborate with others and work as a member of a team
Ability to thrive in a dynamic working environment, multi-task, and adapt quickly
Ability to accept feedback, learn, and adapt from guidance to be successful
Ability to mentor peer group in best practice standards as well as positively spread continuous changes to processes and the responsive health care environment
Have a strong work ethic, passion for our products and our customers' experiences
Foster an inclusive culture of diversity, working well with others
Must be able to meet quality, productivity, and behavior expectations
Knowledge:
Knowledge of company and products in order to up-sell and speak highly of our products and company
Experience:
1 year of customer service experience.
Ability to mentor peer group in best practice standards as well as positively spread continuous changes to processes and the responsive health care environment
Have the capacity to up-sell and speak highly of our products and company
Have a strong work ethic, passion for our products and our customers' experiences
Foster an inclusive culture of diversity, working well with others
Must be able to meet quality, productivity, and behavior expectations
Recent tele-commuting experience a plus
Education and Certifications:
Must have a High School Diploma or GED
College degree or professional certification (Medical Assistant, Certified Professional Coder, Pharmacy Technician) a plus
Bi-lingual (Spanish) a plus
License to sell (a plus, may be required for advanced positions)
Work Environment-Call Center environment
Qualified candidate must be flexible to work any varied shift schedules that may span anywhere between 8:00 a.m. to 8:00 p.m., any day of the week
Minimum Internet Service Provider (ISP) speed requirements for work at home: Approximately 15Mbps download and 5Mbps upload per person working at the remote site (home). Latency (PING) under 150ms Satellite internet is typically not sufficient for real-time communication with tools that support voice or video
Physical Demands:
While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds
Other:
Key Interfaces:
Salesforce
Facets
Bridges
Workflow
Microsoft Office (Outlook, Word, Excel, PowerPoint)
Availity
NICE InContact
Workbench
Prime RxClaims
TruCare
About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
💡 Quick Summary
Seeking a career-building opportunity? The Member Services Representative position is now open for candidates interested in the Work from home Jobs sector. This role in New York offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Work from home Jobs is a plus.
