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ACA Customer Care Representative - Hybrid

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Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

  • Onsite: daily onsite requirement based on the essential functions of the job

  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

This is a highly specialized customer service position focused on the resolution of complaints for individuals and families enrolled with Marketplace coverage. The position requires unique knowledge of the Federally-facilitated Exchange (FFM) regulatory requirements necessary to research, process, and resolve FFM complaint referrals received from Health and Human Services (HHS) through the Health Insurance Casework System (HICS). Responsibilities require intensive research, analysis and strong communication via telephone and written correspondence with members, internal shared services partners, vendor enrollment/billing processors, and CMS Marketplace representatives. Additionally, this role supports research and reconciliation projects for the ACA Program Integrity, as needed. CMS online systems access certification must be obtained.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

  • 1 year experience in health insurance operations role
  • 1 year working with FFM and/or BCBSAZ benefit plans

Required Education

  • High-School Diploma or GED in general field of study

Required Licenses

  • N/A

Required Certifications

  • Access certification/approval through CMS is necessary to access government systems required for the role

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • 2 year(s) of experience in health insurance operations role
  • 2 years working with FFM enrollment processing

Preferred Education

  • Associate's Degree in general field of study

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

  • Retrieve Level 1 and Level 2 HICS complaints from the CMS Health Insurance Casework System.
  • Load appropriate case files to enrollment vendor systems for tracking and conduct an initial review of Level 1 and Level 2 HICS complaints, prioritizing casework by CMS timeliness standards.
  • Conduct in-depth research, utilizing CMS System of Exchange Enrollment Data (SEED), various health plan systems, and communication with internal BCBSAZ teams.
  • Proactively consult and coordinate with various internal departments, vendor partners, and CMS Marketplace representatives to resolve customer complaints with accurate, compliant, customer-focused responses.
  • Identify, coordinate, and monitor completion of enrollment and billing transactions required to resolve complaints.
  • Contact members to discuss complaints, provide timely updates regarding next steps, and communicate final outcomes, applying customer service principles and de-escalation techniques, as needed.
  • Accurately respond to member questions regarding plans and benefits information, as well as other organization services, including automatic payment setup, in-network provider status, wellness incentives, etc.
  • Finalize accurate written member correspondence clearly indicating the outcome of the HICS complaint.
  • Document factual case notes for all HICS cases and each customer interaction in various systems, including but not limited to Salesforce, GetNext and HICS, in accordance with CMS and department quality standards.
  • Apply FFM knowledge to support special projects related to enrollment reconciliation and audits.
  • Meet quality, quantity, and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Demonstrate and maintain current working knowledge of Federally-facilitated Enrollment (FFM) regulations related to HICS Best Practices, and the required BCBSAZ systems, procedures, forms, and manuals.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate skill in the use of computers, Microsoft Office suite, internet browsers, teleconferencing platforms, telephone, and other relevant technology

Required Professional Competencies

  • Every interaction is handled with the utmost care, consideration, and passion for the members we serve.
  • Maintain confidentiality and privacy
  • Practice interpersonal and active listening to achieve high customer satisfaction
  • Compose a variety of business correspondence
  • Interpret and translate policies, procedures, programs and guidelines
  • Capable of investigative and analytical research
  • Navigate, gather, input and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Prioritize, organize and self-manage workload to meet compliance

Required Leadership Experience and Competencies

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced knowledge of enrollment transactions that support FFM reconciliation processes
  • Intermediate knowledge of insurance claim coding
  • Intermediate understanding of medical terminology & medical practices

Preferred Professional Competencies

  • Knowledge of a wide range of subjects pertaining to the organization's service and operations

Preferred Leadership Experience and Competencies

  • N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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