Primarily responsible for the customer service process associated with workers compensation claims which includes servicing customers who contact us via the ACD phone line and supporting the claims management process for all claims teams across the Enterprise.Acts as a back up to the claims intake process. Acts as a backup to the Service Center Business Development and Provider Relations teams on the ACD phone line.
Note- This position has an end time of 6:00 pm.
PRIMARY RESPONSIBILITIES:
Supports the customer service work and processes for the Enterprise claims teams as well as the Subrogation Teams.
Answers claim inquiries from policyholders, agents, injured workers, attorneys, pharmacies, medical providers for multiple jurisdictions for the Enterprise claims teams.Provides verification of claim status for multiple jurisdictions using multiple technology sources.
Performs all facets of IME’s, AME’s, DDE’s, QME’s and any other independent type evaluation needed for the claim file.
Adds legal matters and pertinent litigation information to the claim system upon receipt of legal documents.
Provides backup to the Claims Processing Associates for review, research, and proper routing of priority unidentified claims mail for all brands within the Enterprise.
Processes Claims Subpoenas. Performs all facets of the following referrals:Utilization review, Medical Management, Vocational Rehabilitation, Litigation, and all other Vendor Referrals as requested.
Participates in projects to improve processing and workflow.
Provides PPO, MPN, HCN provider names and/or general program information to customers
Updates claim system with vital information changes.
Updates document management system when claim number changes occur.
Provides backup to intake for multi-state claims processing.
Produces forms, memos, reports, information and letters as requested.
Provides policyholders, agents, and others as requested with copies of first report of injuries.
Corrects department and location information on loss runs as requested.
Inputs data into legal billing system.
Forwards travel documents back to sender requesting additional information.
Types, photocopies, faxes as necessary.
Organizes file materials in date order to be provided to various attorneys and vendors either via the vendor portal or another delivery method.
Assigns services requests to TPA and other vendors via the vendor portal.
Communicates with appropriate state WC division to discuss various issues.
Makes contact with employer and/or injured worker if necessary to obtain information.
May participate with training of team members.
Serves as a resource with creation of documentation of general and state specific procedures as it relates to this position.
Communicates and collaborates with team members to ensure the appropriate and timely handling of claims.
Performs all tasks specified for multiple jurisdictions for all Enterprise Claims Teams.
This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
High School Diploma or G.E.D. required.Minimum of an Associates degree in insurance or related field, but a combination of education and experience may be considered in lieu of formal education.
Minimum of three years general office experience including a minimum of one year in workers’ compensation insurance. Prior experience answering inquires over the phone at AF Group or equivalent relevant internal experience that would provide the required skills, knowledge and abilities. Relevant customer service experience exchanging information and answering basic inquiries over the phone is required
OR
Minimum of four years of general office experience. Two years of customer service experience answering inquiries over the phone in an insurance organization. Prior equivalent relevant experience that would provide the required skills, knowledge and abilities may be considered.
Ability to assist with the creation of procedural documentation and workflows.
Knowledge of CPT, ICD9 and 10, and drug codes
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards. This position has an ending time of 6:00 pm.
#BU
Blue Cross Blue Shield of Michigan is a nonprofit corporation and an independent licensee of the Blue Cross and Blue Shield Association.
BCBSM's commitment to Michigan is what differentiates it from other health insurance companies doing business in the state. That mission has never changed. Nearly 70 years ago, Blue Cross Blue Shield of Michigan started with a purpose to provide people with the security of knowing they have health care when they need it.
Today, that nonprofit mission is the same and the company is accomplishing it in many ways, including:
Offering access to health care coverage for everyone, regardless of circumstances
Never dropping your coverage for health reasons
Partnering with the state to cover more than 32,000 children through MIChild
Providing financial support to 30 free clinics statewide
Contributing more money than any other company to provide Michigan with better health and health care
Advocating and educating through Alliance for Advancing Nonprofit Health Care
For more on the history of BCBSM, please visit our section on historical highlights: http://www.bcbsm.com/home/bcbsm/1930.shtml
