Service/Claims Rep – FEP (3 positions)

BlueCross BlueShield of Western New York
April 24, 2019
Buffalo, NY
Job Type


Provides quality customer service within a high volume contact center to include providing complete, accurate and timely responses to inquiries from subscribers, members and providers; keys, processes and adjusts claims in accordance with the Service Benefit plan (Federal Employee contract Primary Responsibility Responds to and resolves inquiries from subscribers, members, providers, facilities:

  • Communicates and interacts with customers in a written or verbal manner in a clear, unambiguous, concise, professional and empathetic fashion.
  • Handles all inquiries and services incoming and outbound calls and correspondence.
  • Considers all aspects or elements in a logical manner; considers contractual provisions and options to resolve inquiry; communicates with internal and external customers.
  • Utilizes and interprets appropriate reference materials and other necessary resources in responding to inquiries.
  • Communicates with internal and external customers via phone, personal contact (lobby walk-ins), email, online chat or in writing; utilizes Letter Reference Guide (LRG) and FEP Direct templates as necessary.
  • Takes ownership of problems and establishes relationships with all customers meeting all corporate guidelines.
  • Demonstrates an ability to communicate complete benefits and requirements to the customer.
  • Identifies potential problems and inconsistencies and forwards to Sr. Representative and/or management for solution. Keys, processes and adjusts claims through the Federal Employee Program:
  • Performs online transactions and/or adjustments using the Corporate Claims. administration system and FepDirect system, while adhering to Corporate and FEP guidelines.
  • Determines claim disposition by reviewing correspondence, coordination of benefits (COB) information, and claim inquiry history; follows desk levels, standard operating procedures and COB guidelines.
  • Researches, tracks, and follows up on information regarding claim benefits, eligibility and all other aspects of business.
  • Updates appropriate systems to reflect accurate information.
  • Identifies potential fraud cases and forwards to Special Investigations Unit. Performs all job duties efficiently, accurately and at an acceptable level of performance. Performs related clerical duties:
  • Faxes, copies documents. Maintains confidentiality and adheres to HIPAA regulations. Delivers customer service in a professional, polite and efficient manner. Performs other duties of a similar nature that are not inconsistent with this position or pay grade. Knowledge and Skills Must meet qualifications to perform the job including satisfactory completion of all training and testing Customer Service Representative tests - passing score Ability to multitask in fast paced service environment Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner Ability to effectively communicate in both written and verbal communication with internal and external contacts, in a professional manner Working knowledge of personal computer and application software such as Microsoft Office Ability to utilize basic office equipment including PC, scanner, telephone, copier, printer, fax, calculator Computer Software typically used: Microsoft Word, Facets/Streamline, PEGA/PRPC, Content Manager, FepDirect Qualifications Problem-Solving Skills: Identifies problems and inconsistencies; recognizes major issues, identifies key facts; Seeks information.


Company Description

BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., one of New York’s leading health care companies that provides access to quality health care and innovative solutions for members throughout upstate New York. Headquartered in Buffalo, NY, the company is an independent Licensee of the BlueCross BlueShield Association.

We have helped millions of people gain access to outstanding health care. Today, we are focused on improving quality and outcomes through strengthened alliances with our members, providers, and third-party partners. And, as we lead the way to the future of health care, our products, programs and services will inspire healthier living by:

• Increasing access to ensure members get the care they need anytime, anywhere; helping members understand and optimize their benefits; rewarding healthier lifestyles; supporting community-based wellness initiatives; and advocating for healthier public policies

• Partnering with doctors and hospitals to improve the quality of care all patients receive, better manage costs, support preventive care initiatives and evidence-based medicine, and drive adoption of electronic medical records and health information exchanges

• Simplifying doing business with us