**Experienced Customer Service Representative - Federal FFS at blithequark**

Are you passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others? Do you thrive in a dynamic, fast-paced environment where no two interactions are ever the same? If so, we invite you to join blithequark as an Experienced Customer Service Representative - Federal FFS. At blithequark, we're committed to revolutionizing the healthcare industry by providing personalized, convenient, and affordable solutions that put our members at the forefront of everything we do. Our Heart At Work Behaviors™ are the foundation of our culture, empowering every team member to feel empowered, valued, and connected to our purpose. **Position Summary** As a Customer Service Representative - Federal FFS at blithequark, you'll be the face of our organization, impacting the lives of our members through every interaction. You'll be responsible for handling customer inquiries and resolving issues via phone, internet, or written correspondence, demonstrating empathy, compassion, and a deep understanding of our members' unique needs and preferences. **Key Responsibilities** * Engage, consult, and educate members on Aetna plans, tools, and resources to guide them along a clear path to care * Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors * Triage resulting rework to appropriate staff * Document and track contacts with members, providers, and plan sponsors * Guide members through their plan of benefits, Aetna policy and procedures, and regulatory guidelines * Create an emotional connection with members by understanding and engaging them to champion their best health * Anticipate customer needs and provide related information to answer unasked questions * Use customer service threshold framework to make financial decisions to resolve member issues * Explain member's rights and responsibilities in accordance with contract * Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via target system * Educate providers on self-service options and assist with credentialing and re-credentialing issues * Respond to requests from Aetna's Law Document Center regarding litigation and lawsuits * Handle extensive file review requests and assist in preparation of complaint trend reports * Assist in compiling claim data for customer audits and determine medical necessity, applicable coverage provisions, and verify member plan eligibility * Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management * Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible * Perform financial data maintenance as necessary * Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received **Essential Qualifications** * High School or GED equivalent * Customer Service experience in a transaction-based environment, such as a call center, demonstrating ability to be empathetic and compassionate * Experience in a production environment * Ability to commute on-site to High Point, NC office 5 days per week during first 8 weeks of initial training * Team will transition to full-time work from home following training **Preferred Qualifications** * Medical Terminology and/or Provider office experience * Understanding of insurance concepts and processes **Skills and Competencies** * Excellent communication and interpersonal skills * Ability to work in a fast-paced, dynamic environment * Strong problem-solving and analytical skills * Ability to multitask and prioritize tasks effectively * Proficiency in using applicable system tools and resources * Strong attention to detail and accuracy * Ability to work independently and as part of a team * Strong customer service skills, with a focus on empathy and compassion **Career Growth Opportunities and Learning Benefits** At blithequark, we're committed to helping our team members grow and develop their careers. We offer a range of training programs, mentorship opportunities, and career development resources to help you achieve your goals. Our team members also have access to a range of benefits, including: * Medical, dental, and vision benefits * 401(k) retirement savings plan * Employee Stock Purchase Plan * Fully-paid term life insurance plan * Short-term and long-term disability benefits * Well-being programs * Education assistance * Free development courses * CVS store discount * Discount programs with participating partners * Paid Time Off (PTO) or vacation pay * Paid holidays throughout the calendar year **Work Environment and Company Culture** At blithequark, we're proud of our inclusive and supportive work environment. Our team members are passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others. We're committed to creating a culture that values diversity, equity, and inclusion, and we're dedicated to providing a safe and welcoming space for all team members. **Compensation and Perks** The typical pay range for this role is $17.00 - $25.65. In addition to your compensation, you'll enjoy a range of benefits and perks, including: * Medical, dental, and vision benefits * 401(k) retirement savings plan * Employee Stock Purchase Plan * Fully-paid term life insurance plan * Short-term and long-term disability benefits * Well-being programs * Education assistance * Free development courses * CVS store discount * Discount programs with participating partners * Paid Time Off (PTO) or vacation pay * Paid holidays throughout the calendar year **How to Apply** If you're passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others, we invite you to apply for this exciting opportunity. Please submit your application by [08/23/2024]. 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