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Louisiana Blue · 1 day ago

Account Advisor I

Corporate - Baton Rouge, LA

Full-time

Hybrid

Entry Level

1+ years exp

Louisiana Blue is a health service organization seeking an Account Advisor I to serve as the first point of contact for members and providers. The role involves handling incoming calls, resolving benefit and claims inquiries, and promoting a positive company image through excellent customer service.

Health CareInsuranceNon Profit

Responsibilities

Serves as first point of contact for the organization

Handles incoming calls from members and providers answering questions and offers guidance via the telephone with individuals in a prompt, courteous, and professional manner

Resolves benefit and claims inquiries received via the telephone, in person, or other acceptable receipt method from our members or providers in the call center

Promotes and maintains a positive company image through direct contact with customers

Complies with all laws and regulations associated with duties and responsibilities

Reviews and researches billing and healthcare claim inquiries from members and providers, to ensure proper benefits and/or payments are applied correctly; researches multiple computer systems/applications to verify data/information accuracy

Responds to inquiries regarding adjustments, refunds, edits and/or payment registers to ensure completeness, accuracy and customer satisfaction to members or providers

Maintains knowledge of required lines of business, changes to applicable company policies/procedures, recent laws and regulations, and related computer systems to ensure information is current and accurate when providing service to members or providers on the telephone in the call center

Meets Customer Service performance goals/expectations in the areas of efficiency, accuracy, quality, production, customer satisfaction, and attendance

The ability to verbally communicate on the telephone approximately 95% of the time

Account Advisor Is who work on the Medicare LOB must be able to follow CMS (Center for Medicare and Medicaid) standards including but not limited to: following a defined process for handling Medicare Grievances, identify differences between an inquiry, grievance, & appeal, and meet specific schedule requirements (may have to work nights, weekends and/or holidays)

Performs other job-related duties as assigned, within your scope of responsibilities

Qualification

Customer Service experienceMedical terminology knowledgePC skillsConflict resolution skillsCritical thinkingAttention to detailEffective communicationOrganizational skillsActive listeningProblem solving

Required

Customer Service experience or equivalent

Must be available to report to the Baton Rouge Corporate Campus for the onsite components of new hire training

Commitment to training program

Hardwired internet connection with speeds greater than 5MB upload and 10MB download

High School Diploma or equivalent preferred

1 year of customer service or medical office experience required

Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC, can be used in lieu of the one year of experience

A certificate in medical office assistant or medical coding can be used in lieu of the one year of experience

Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook , etc.) and related software as other corporate software programs and applications

Demonstrated verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism

Conflict resolution skills and remains calm under pressure/stressful situations

Must be able to demonstrate critical thinking and problem solving skills

Demonstrate attention to detail

The ability to actively listen and ask appropriate questions, to effectively understand issues that are presented from customers

Reading comprehension skills are required due to the high amount of direct customer contacts and the need to understand customer contract benefits and training materials

Effective organizational and interpersonal skills are required. Must have the ability to multi-task and handle work independently as well as organize and prioritize multiple customer issues

Ability to take ownership of issues from the beginning, seeking First Call Resolution (FCR)

Must be able to verbally communicate on the telephone in a call center environment approximately 95% of the time in the Customer Care Center

Employees may be expected to work during inclement weather or other emergency situations when needed

Must have ability to successfully complete Customer Service training, with demonstrated proficiency in training materials