Job ID: JP00044388

Anticipated Start Date: 04/15/2024

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Responsible for functioning on a learning curve to become fully proficient in all aspects of customer service, claims and/or membership issue resolution. Performs research and analysis, advocating on behalf of customers through whole case methods. Learns to provide full service to members, providers, group administrators, and brokers by processing health care claims, handling inquiries, and/or performing membership functions. Performs at least two of the three functions routinely.

Primary duties may include, but are not limited to:

• Receives inbound telephone calls or paper and electronic claims from members and providers.
• Resolves issues for members, providers, group administrators and brokers.
• Analyzes the situation and completes research to ensure no rework or follow-up issues.
• Applies knowledge of policies and procedures, products, legislation and claims workflow.
• Interacts with systems to ensure claims are paid or denied based on terms of contract.
• Answer inbound calls to the Member Services Department using the Plan’s standard greeting.
• Respond to caller’s inquiries and resolve member, vendor, and provider requests for information and member materials.
• Provide accurate information to callers regarding benefits, Member Handbook, and other requested information, as appropriate.
• Research, identify, and resolve caller’s complaints using applicable resources and systems.
• Warm transfer calls to appropriate individuals, as required.
• Identify and escalate issues, as appropriate.
• Document all call outcomes in the electronic medical record system.
• Maintain and update member records with pertinent information, as necessary.
• Advise Members of the Plan’s grievance and appeals processes, the service authorization process, and the Member’s right to a fair hearing and/or external review.
• Develop and maintain effective working relationships with members, service providers, and all members of the care management team.
• Facilitate language translation and communications assistance for callers requiring special accommodations.
• Maintain knowledge of Medicaid/Medicare eligibility requirements, MLTC regulatory requirements, and internal policies and procedures.
• Provide all callers with excellent customer service and handle all calls in a respectful, culturally sensitive manner.
• All other duties as assigned.

Requirements:

• Requires HS diploma or equivalent.
• 3-6 months experience in an automated customer service environment; demonstrated ability to listen effectively, use probing skills to obtain relevant information and establish rapport quickly with customers and co-workers; or any combination of education and experience, which would provide an equivalent background.

Job Type: Contract opportunity.

Additional Details:

• Shifts: M-F 8-5 EST.
• Flexible on hours.
• 100% remote opportunity.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.