Customer Service Representative I at Blue Cross Blue Shield of Michigan in Detroit, Michigan

Job Description:

Analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. 

• Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership. 


• Analyze and service various product lines in the area (i.e., Facility, Professional).  Provide responses by telephone, check-off letters, and/or automated letters.


• Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts). 


• Organize work to meet National/Corporate/Department Production and Quality Standards. 


• Reroute misdirected inquiries. 


• Primarily evaluates membership issues/inquiries and price/adjudicates low complexity claims/inquiries. 


• Interact with others inside and outside the organization to resolve the inquiry/claim related problems. 


• Influence customers to accept the reasonableness of decisions and actions. 


• Other duties may be assigned.

" Qualifications"

Education and Experience

• High school graduate or GED equivalent.


• One (1) year of related work experience in areas such as public/customer service, sales representative, claims processing, membership enrollment or one (1) year of public contact in positions such as teaching, social service work, bank teller, medical assistant/office assistant.


• One (1) year of total related experience or in the absence of internal BCBSM experience, the following may apply:  One (1) year of related work experience in areas such as public/customer service, sales representative or claims processing.


• Demonstrated knowledge of policies, practices and procedures related to membership.


• Demonstrated ability to analyze data and resolve problems related to membership.


• Demonstrated command of all skills necessary for oral and written communications in a clear, concise and tactful manner.