BCN Field Specialist at Blue Cross Blue Shield of Michigan in Southfield, Michigan

Job Description:

Analyze, investigate, resolve and respond to sensitive/complex issues, providing support for managing agents, agents, employer group representatives and sales staff.  Act as subject matter expert on complex products and during open enrollments, health fairs, and employee meetings.  Assist with benefit interpretation and in the resolution of claim issues, administrative presentations, member retention and increasing new membership.

• Visit assigned location(s) and identify problems/discrepancies in interpretation of BCN administrative processes and take necessary steps to correct the problem.  Act as a liaison between group/agent and appropriate departments and communicate final resolution of the issue to customer. 


• Educate groups/agents/managing agents/sales staff on administrative guidelines and products through formal educational programs and training presentations. 


• Work with sales staff, training areas and Corporate Communications to develop training materials, marketing materials and educational literature.


• Develop and maintain effective and professional relationships with internal and external customers at all leadership levels, including executive leadership. 


• Assist in the resolution of claim issues and interpretation of benefit inquiries received from employer group representatives, managing agents, agents, union benefit representatives and sales staff.


• Analyze claim data/reports and benefit documents; investigate and resolve issues with assistance from appropriate internal departments through MACESS documentation. Ensure that accurate/timely resolution of customer concerns is communicated to the internal or external customer.  


• Assist sales staff and participate in community activities to promote a positive image of BCN and its products.


• Identify and/or analyze improvement opportunities for employer groups and agents. 


• Coordinate mailings for new group benefits, and administrative mailings as needed.


• Work with key departments on new technologies (i.e. MACESS, Facets, etc.). Develop and conduct new system training for account service reps and managing agents.  


• Participate in corporate committees and workgroups.

• Bachelor’s Degree with an emphasis in Marketing, Business or related field required.  Education degree or a health-related field preferred.


• Four (4) years experience in a health insurance setting including two (2) years of customer service experience involving face-to-face customer contact.


• Extensive knowledge of BCN departmental and corporate policies and procedures that impact inquiry processing and in-depth knowledge of BCN certificates, riders and benefits required.  Must be able to explain and apply benefit language in layman’s terms.


• Intermediate knowledge of Microsoft Office Suite software products.


• Demonstrated ability to train and develop effective training materials required.  Knowledge of instructional design principles and training theory preferred


• Knowledge of membership and billing workflow/techniques, claims, eligibility and membership/billing and rating and underwriting functions preferred.


• Knowledge of BCN administrative policies and procedures preferred.


• Extensive knowledge of HMO/Health insurance industry terminology preferred.


• Knowledge of federal regulations and guidelines, such as TEFRA, DEFRA, COBRA ERISA, HIPAA and other federal regulations and guidelines as needed preferred.


• Excellent verbal/written communication, organizational/planning and interpersonal skills including the ability to interact with internal/external customers at all levels of an organization.


• Strong customer-focus and sense of urgency with the ability to be flexible to changing circumstances and customer needs required.


• Valid Michigan drivers’ license with the ability to travel to various locations.


• Other related skills and abilities may be required.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.