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Arkansas Blue Cross and Blue ShieldCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing and customer service, with a strong focus on accuracy, quality standards, and effective communication. Capable of mentoring team members and fostering a collaborative work environment while maintaining dependability and sound judgment.
Highest-signal resume keywords
Claims ProcessingCustomer Service ExperienceOral & Written CommunicationDetail-OrientedPeer Mentoring
About the role
Key responsibilities & impact- Ensure timely and accurate claims processing by monitoring and analyzing Claims Specialists' workflow
- Handle difficult and sensitive situations and escalate issues to the supervisor as necessary
- Make decisions within the limits of plan documents and company policies
- Request exceptions or appropriate authority review when unusual situations arise and the supervisor is unavailable
- Maintain a positive and productive work environment in the absence of a supervisor
- Work with Claims Trainers to ensure appropriate and consistent initial and ongoing employee training
- Assist the supervisor during interviews for new employees
- Mentor team members and provide assistance with work-related functions
- Provide feedback and coaching regarding performance and quality standards
- Foster teamwork and maintain working relationships with management and staff in supporting departments
- Analyze claims workflow to identify trends requiring attention
- Review processes, identify training and development needs, and enhance individual team-member workflow
- Monitor claims for accuracy and timely processing
- Answer customer-related inquiries and process pended claims as needed
- Perform other duties as assigned
Requirements
What you’ll need- High School diploma or equivalent
- Minimum two (2) years' claims processing or customer service experience
- Demonstrates above average production, quality standards and dependability as specified by the functional area
- Detailed knowledge about all ABCBS health insurance plans and/or groups supported by the team, including expertise in benefit and claims processing guidelines preferred
- Oral & Written Communication
- Strong Interpersonal skills
- Sound Judgement
- Decision Making
- Detail-Oriented
- Teamwork
- Dependability
- Keyboarding
- Computer Literacy
- Taking Initiative
- Peer Mentoring
- Demonstrated ability to successfully assist with special requests and/or projects
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingComputer LiteracyKeyboardingBenefit Guidelines KnowledgeClaims Processing Guidelines Knowledge
Soft Skills
Strong Interpersonal SkillsSound JudgementDecision MakingTaking InitiativeTeamwork
Industry Keywords
Health Insurance PlansClaims Workflow AnalysisEmployee TrainingPerformance FeedbackQuality Standards