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For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs. Our mission: Being the insurer Kansans trust with their health. Our Commitment to Diversity, Equity, Inclusion, and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.

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🔥 Remote Assistant Supervisor CSC MA Operations

Posted 1 day ago

📍 United States of America

💸 26.34 - 32.93 USD per hour

🔍 Customer Service

🔧 Requirements

High school diploma or equivalent required.
Leadership and team management skills with the ability to effectively motivate, assist with developing employees, while maintaining consistent teamwork mentality.
Clear and effective written and verbal communication skills and proven ability to complete work at a satisfactory level.
Proficient time management skills with a proven ability to meet deadlines.
Strong analytical and critical thinking skills.
Ability to prioritize tasks and to delegate when appropriate.
Ability to function effectively in a high-paced and at times stressful environment.
Leadership experience or two years Customer Service experience with BCBSKS required.

💡 Responsibilities

Assist supervision in managing workflow and assessing employees’ work performance to identify areas of improvement.
Exercise effective communication and interpersonal skills to build positive relationships with other internal areas to aid in timely completion of inquiries.
Complete or acquire timely and accurate reports as needed for assessment and trending of operational activities, performance etc.
Foster loyalty in employees and assist with coaching staff for personal development.
Exercise sound business judgment independently and in a team environment.
Consistently demonstrate the motivation and skills necessary to effectively resolve problems.
Perform assigned job-related duties as required, including any special projects.

LeadershipPeople ManagementCommunication SkillsAnalytical SkillsProblem SolvingCustomer serviceTime ManagementCoachingTeam management

Posted 1 day ago

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🔥 Remote Medicare Advantage Appeals and Grievances Specialist

Posted 1 day ago

📍 United States of America

💸 54758.4 - 68486.4 USD per year

🔍 Medicare Advantage

🔧 Requirements

High school diploma or equivalent.
Two years of customer service experience.
Three years of MA Appeals and Grievances experience.
Ability to interact positively with internal and external customers while demonstrating empathy, adaptability, and listening skills.
Ability to listen, talk type and perform research simultaneously using various research channels.
Excellent reasoning, analytical, problem-solving skills, and sound judgment.
Capacity to conduct extensive research, provide analyses and solutions to unusual or recurring issues, at times using discretion.
Efficiency in managing dissimilar issues, determining priorities and meeting regulatory and/or company deadlines.
Advanced human relations, oral and written communication skills.
Ability to maintain strict confidentiality in handling data related to job duties.
Able to work collaboratively and cooperatively as a team member.
Ability to work within a self-initiated environment with little supervision.
Ability to achieve production-based performance goals.
Technical skills to effectively use computer programs and troubleshoot simple computer issues independently or with direction.
Ability to adhere to a rigid schedule and have regular and predictable attendance.
Obtain and maintain any departmental or legally required certifications (e.g. CMS or BCBSA requirements.)
Working knowledge of Blue Cross and Blue Shield of Kansas’ MA and other relevant systems is required.
Detailed knowledge of MA line of business and regulations governing MA appeals and grievances is required.

💡 Responsibilities

Create and compose correspondence in response to MA member, member representative or provider appeals and grievances cases to ensure all regulatory guidelines are met.
Interpret, analyze, and review all MA benefit offerings and their relevant language, corporate policies, administrative and operating procedures, information systems, and regulatory guidance to address a variety of issues which may not be clear or direct.
Manage time to optimize and prioritize work to ensure goals (internal, regulatory, etc.) are met in a fluctuating environment.
Use discretion to make judgment calls determining appropriate sources, directions, and parameters necessary to review and resolve issues in an extremely diverse, complex, and challenging business and regulatory environment. This can include interaction with a variety of internal and/or external contacts.
Develop effective working relationships with staff at every level within BCBSKS, other Plans, CMS Caseworkers or Account Manager, relevant suppliers and contractors, providers, and/or members and their representatives.
Serve as a backup to the MA Customer Experience Representatives as business needs dictate. This involves researching, resolving, and responding to inquiries and correspondence via telephone, written and email communication. Inquiries may be regarding MA benefits, eligibility, coverage and plan changes, payments, claims, prior authorizations, appeals, and grievances.
Perform additional duties as required, including any special projects.

Communication SkillsAnalytical SkillsCustomer serviceAttention to detailProblem-solving skillsResearchEmpathyActive listeningAbility to learnData entryComputer skills

Posted 1 day ago

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