Health Services Technician - Remote AZ

PURPOSE OF THE JOB

Responsible for research and triage of records and other documentation to ensure requests are processed accurately, timely, professionally and according to regulations. Works with team, providers and members to provide services that put our member first.

REQUIRED QUALIFICATIONS

Required Work Experience

• 1 year experience in healthcare, health insurance, or related customer service (Level
  1)
• 3 years experience in healthcare, health insurance, or related customer service (Level
  2)
• 5 years experience in healthcare, health insurance, or related customer service (Level
  3)

Required Education

• High-School Diploma or GED in general field of study (All Levels)

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 1 years experience in healthcare, health insurance, or related customer service and 1 year experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field (Level
  1)
• 4 years experience in healthcare, health insurance, or related customer service and 2 years experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field (Level
  2)
• 6 years experience in healthcare, health insurance, or related customer service and 3 years experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field (Level
  3)

• Associate's Degree in general field of study

• N/A

• N/A

Level 1 – Performs job functions under general supervision or peer review

• Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
• Answer a diverse and high volume of health insurance customer calls or correspondence on a daily basis.
• Maintain complete and accurate records per department policy.
• Maintains member information in a confidential manner and ensures HIPAA compliance at all times.
• Meet quality, quantity and timeliness standards to achieve individual and departmental performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
• Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, community resources, provider networks, etc.
• Demonstrate ability to apply plan policies and procedures effectively.
• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
• Research, gather and conduct preliminary analysis of data for department and corporate reporting.
• Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
• Ensure confidentiality and control access to sensitive information.
• Maintains productivity and accuracy requirements set for this level.
• Assists in development of procedures and/or desk levels for assigned processes, as needed and develops and assists in implementation of new policies and/or desk levels.
• Maintains effective communication with internal and external customers.
• Maintains knowledge of activities in assigned area and possesses the ability to provide assistance as necessary.
• Able to work effectively and collaboratively with interdisciplinary teams.
• Positively adapts to a changing work environment with flexibility and recognizes the impact the change will have on the department process.
• Adapts to changing work environment with flexibility and recognizes potential impact with ability to accentuate the positive to maintain/increase staff morale.

Level 2 - Performs job functions with moderate supervision and peer review

• When indicated to assist with team/project functions:
  • Collaborate with team to distribute workload/work tasks;
  • Monitor and report team tasks;
  • Communicate team issues and opportunities for improvement to supervisor/manager;
  • Support/mentor team members.
• Assists in departmental…