FEP Benefit Processor / CSR I

HMSA
United States, Hawaii, Honolulu
818 Ke’eaumoku Street (Show on map)
Oct 24, 2024
Review, assess and deliver accurate and timely responses to eligibility, benefit and basic claims status inquiries using multiple systems and resources to research information (i.e., QNXT, Documentum, 837 Database, Mainframe, ASSIST, FEPDirect, FEPBlue.org, BlueWeb.org, PC software). Effectively apply reasoning and problem solving and successfully complete interactions with internal and external customers to achieve high quality customer-centric delivery of service. This will include: Efficiently and comprehensively identify the inquirer's reason for contacting us. Adapt our response delivery to address all issues in a positive and helpful manner providing information and education of clarifying concepts when necessary. Share our internal expertise of the benefit and processes to resolve Member and Provider inquiries. Apply sound decision making to request and compile appropriate supporting documentation as required by the FEP Director's Office or the FEP Operations Center to update, correct or initiate member enrollment or demographic information, plan primacy order, servicing authorization, TPL case pursuit, and other documentation as needed. Collaborate with internal departments that support FEP benefit and claims processing activities such as Medical Management, Customer Relations and Finance & Accounting to ensure consistent delivery of information and services. Exhibit mature ability to respond verbally, in person and in writing to internal and external customer's inquiries on enrollment, eligibility, benefits and claims adjudication questions in a professional, accurate and timely manner. Identify problematic issues in policy or process that result in unintended negative consequences for the Member or Provider. Promptly present case details, recommend solutions, and/or corrective action to management to minimize unfavorable customer impact. Performs all other miscellaneous responsibilities and duties as assigned or directed.