Customer Service Rep I

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

This position is accountable for providing timely and accurate customer service through routine inquiries from insured's and providers regarding billing, general claim questions, credentialing and case management within Horizon Casualty Services, Inc. Communicates information regarding status on billing claims and provider network participation.

Responsibilities:

• Responds to general questions from insured and providers regarding provider networks, billing, correspondence, and claims.

• Coordinates claim activities on behalf of insured and providers by interacting with medical and case management personnel to provide information and resolve issues.

• Performs routine research related to claim history, contract benefits, and system guidelines to determine over payments, duplicates, under payments, or receipt of no payment for claim resolution.

• Refers non-routine claim inquiries to Nurse Case Managers, Nurse Advocates or Medical Payment Specialist if inquiry cannot be determined from available resources.

• Responds to pre-certification request and three-(3) point contact inquiries by identifying current claim status.

• Responds to customers on check inquiries and payment resolutions.

• Completes other assigned functions as requested by Management.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

• High School Diploma/GED required.

• Requires a minimum of two (2) years customer service experience.

Knowledge:

• Requires working knowledge of personal computers and supporting software in windows based environment including MS Office Products and email application systems.

• Prefers knowledge of medical terminology and/or case management services.

• Prefers knowledge of NJ Workers' Compensation and No-Fault laws.

Skills and Abilities:

• Information gathering

• Problem Solving

• Flexibility

• Structure

• Planning/Priority Setting

• Teamwork

Salary Range:

$35,000 - $45,990

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.