Capital Blue Cross ยท 4 hours ago
SR Client Svcs Support Analyst
Harrisburg, PA
Full-time
Onsite
Mid, Senior Level
3+ years expCapital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, dedicated to improving the health and well-being of its members and communities. The SR Client Svcs Support Analyst is responsible for conducting research and providing problem-solving support to the Customer Service Department, ensuring compliance with organizational and regulatory requirements while delivering professional quality service to clients and brokers.
ConsultingHealth CareHealth InsuranceProfessional Services
Responsibilities
20% - Researches and reviews customer inquiries as related to one of our Vendor LOB. Determines appropriate action by reviewing and interpreting applicable policies/procedures that are within the established regulatory requirements. Utilizes the PC, manuals, online reference materials, Imaging, etc., to obtain benefits, enrollment and claim information
20% - Ensures the satisfactory resolution of routine and complex Vendor inquiries including, but not limited to, benefits, claim filing and processing, collection issues, enrollment discrepancies, legal requests, Medicare Secondary Payer, Plus Billing and payment requests, Third Party Administrators, COBRA, reinstatements, conversions, refunds, new enrollment, transfer situations, student certifications, handicapped dependents, for all lines of business administered and supported by Capital BlueCross and Avalon. Conducts specific job related instructional sessions as requested by Supervisor
15% - Be able to prioritize work, communicate and share information with the team as necessary. Respond to customers inquiries via telephone, correspondence, on-site, Fax, Secure IT, E-mail and personal interviews from individual customers, group administrators, providers, Capital BlueCross personnel, Host Plan personnel, attorneys, and outside entities working on the customer's behalf
10% - Monitors Vendor related inquiries utilizing various system generated reports for accurate and timely resolution to ensure customer satisfaction and compliance with MTM (Member Touchpoint Measures), PPACA, ERISA, and Act 68 quality, and timeliness guidelines
10% - Provides clear and concise instructions to the appropriate Plan area, in the approved format (e.g., electronic, on-line or hard copy forms, telephone contact) for the resolution of the issues
5% - Contacts the appropriate internal/external entities (e.g., groups, providers, Marketing, Legal, Host Plans, Vendor contacts etc.) to obtain information and initiate necessary action
5% - Enters all information necessary to update the Facets inquiries, Sales Force Case, or Work Desk when appropriate, for tracking inquiry/Sales Force activity and keep notes updated on progress through resolution. Utilizes the system to obtain background information and prevent duplication of effort
5% - Report trends to management that may indicate processing problems, lack of documentation or appropriate information concerning claims, enrollment areas, benefits, policies and procedures
5% - Assists/participates with Marketing personnel and the broker community in the support of customer needs by researching and communicating information to other Company personnel or directly to the customer. May attend or participate in marketing related activities as a representative of Capital BlueCross (e.g., open enrollment, on-site visits, etc.)
5% - Performance standards, business metrics and process improvements to include:@@Complete ongoing training to stay abreast of product, service and policy changes@@Improve our quality of work on a daily basis by learning and employing new skills@@Recognize, document and alert the supervisor of trends in customer service inquiries@@Conduct yourself in a manner consistent with the values of the organization
Qualification
Required
3 years customer service or correspondence experience or experience/training in a writing-intensive role is required
High School degree or equivalent
Demonstrates ability to communicate effectively and professionally both verbally and in writing with all levels of internal/external personnel in order to respond to customer inquiries ranging from routine to complex and involving sensitive subject matter
Demonstrates ability to understand and interpret detailed policies and procedures and to be able to apply them to various situations. This includes thorough understanding of CBC's responsibility to maintain privacy of Protected Health Information as required by the Health Insurance Portability and Accountability Act
Demonstrates ability to work independently, be flexible and react appropriately to changing job assignments and work environments
Demonstrates analytical, organizational, and problem solving skills in order to accurately and efficiently identify, analyze and respond to customer/provider inquiries, as well as identify and analyze trends and discrepancies
Familiar with, or ability to, operate a PC and associated software; Microsoft Word, Excel, etc., phone equipment, calculator, fax, copier, and other department required hardware
Demonstrated competency in Windows (Outlook, Word, Internet Explorer, Excel and PowerPoint), SharePoint, and Sales Force
Above average reading, writing and arithmetic skills required (reading/math comprehension)
Knowledge of benefit programs administered and/or supported by Capital BlueCross. Includes Medicare Advantage, Medicare Part D and Medicare Supplemental Programs, Dental, Vision, Chiropractic, Prescription Drug, Benefits Management, and Disease Management
Knowledge of the PBM and Facets health plan administration processing systems as well as online files for determining enrollment, billing, and benefits. Knowledge of benefits administration policies, customer billing processes, claims processing and general procedures
Knowledge of ERISA, Act 68, and BCBSA MTM,PPACA, HIPAA quality and timeliness guidelines and standards to ensure they are consistently met or exceeded
Knowledge of Account Administration regulations, policies and procedures pertaining to Capital BlueCross and transfer of enrollment information to all our vendors
Knowledge of multiple online inquiry systems and coding structures of files to interpret data used in responding to inquiries and Sales Force cases
Preferred
Experience with customer interaction preferred
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Company
Capital Blue Cross
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
1001-5000 employees
H1B Sponsorship
Capital Blue Cross has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (13)
2023 (5)
2022 (9)
2021 (5)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Glenn Heisey
Executive Vice President and Chief Operating Office
Recent News
2025-10-02
2022-10-14
Company data provided by crunchbase