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Benefit Processor / CSR Trainee (Federal Employee Program)
Exempt or Non-ExemptNon-exempt
The FEP Benefit Processor/CSR Trainee is responsible for providing assistance to our Member and Providers by telephone, in-person, and written correspondence. Expected servicing requirements include accurate and timely responses to ensure a level of satisfaction that meets or exceeds our FEP contractual performance requirements. Work impacts the timeliness, quality and cost of work in the department and contributes towards HMSA's mission to deliver exceptional service and outstanding results to our customers.
Gain working knowledge (learned through successful completion of training and on-the-job) of standard procedures, products, rules and instructions to perform full range of assignments. Respond to inquiries and resolve recurring problems that include enrollment, benefits and claims processing information and procedures.
The Trainee must successfully complete training and exhibit the necessary skills to perform essential duties and other tasks expected of this position. Completion of the FEP training examination with a score of no less than 90% is required within one year of hire.
- High school and 18 months of related work experience or equivalent combination of education and work experience
- Good verbal and written communication skills.
- Good working knowledge of Microsoft Office applications.
- Must complete the FEP training examination with a score of no less than 90% within one year of hire.
Duties and Responsibilities
a. Successfully progress through and complete on-the-job training 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.
b. 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). 30%
c. 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.
d. Other Duties:
Perform other support functions as assigned.