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Customer Service Representative (BlueCard -Kapolei, RFT)


Posted: 10/2/2019
Job Reference #: 5000478685406

Job Description

Employment Type


Exempt or Non-Exempt


Job Summary

Be the first point of contact for inquiries regarding out-of-state medical claims. Receive incoming telephone calls, emails or correspondence from HMSA members, doctors or hospitals, and internal departments. Resolve routine concerns and use probing questions to gather information needed to escalate more complex issues. Provide considerate, positive and accurate responses to promote first call resolution and ensure a great customer experience with each contact.

Minimum Qualifications

  1. High school diploma or GED with at least eighteen months of work experience that involved interaction with customers or equivalent combination of education and work experience.
  2. Excellent verbal and written communications skills
  3. Basic working knowledge of Microsoft Office applications and standard office equipment
  4. Overtime may be required to meet business needs. Hours may include weekends and holidays as requested and approved by management.

Duties and Responsibilities

  1. Successfully complete on the job training and periodic BlueCard certification requirements
    • HMSA products and policies
    • BlueCard program and policies
    • Claims processing basics
    • Multiple applications and resources
    • Customer experience and other performance measures
  2. Assist members, doctors or hospitals, and internal departments with their medical claims inquiries via telephone, email or correspondence.
  3. Escalate complex claims issues to BlueCard Customer Advocates for further research and coordination of resolution activities
  4. Create clear and concise documentation of all customer interactions as required for escalation or audit purposes.
  5. Other Duties As Assigned:
    • Complete assignments related to project work as assigned by management
    • Innovation, process improvement activities