Client Advocacy & Resolution Expert (CARE)

Additional Locations:Job DescriptionResponsible for a customer-facing, service relationship with clients, maintaining a high level of engagement around service delivery, issue resolution and healthcare initiatives unique to clients. Takes a multi-faceted and creative approach in managing the overall service strategy for the client. Partners with internal teams to maintain compliance with contractual agreements, effective cost control measures, policies, procedures and workflows to resolve service inquiries. Drive excellence in sales delivery and support by efficiently and effectively addressing needs and issue escalations expressed by internal team members. Build sustainable relationships with internal team members by providing market-leading service and support experience.About Commercial Markets at Blue Cross NCThe Commercial Markets group is responsible for sales, retention, market strategy, pricing, and product and segment performance for our commercial business. The division is also responsible for reporting, sales technology, product piloting and product management operations for both the Government Markets and Commercial Markets Divisions. Our commercial product segments are individual, under 65; local group; major group; specialty segments and the State Health Plan.In your role as a Client Advocacy & Resolution Expert (CARE), you will work primarily with the HR Group Administrators and brokers on a daily basis, depending on if the group assigned has a designated broker. You will be the internal one-stop point of contact acting as a liaison for Group Administrator escalations – reaching out to internal stakeholders and externally as needed (providers, vendors, etc.) to obtain the resolution needed.What You’ll Do

Identifies, analyzes and resolves complex operational issues impacting clients. Intake, manage, track and resolve inquiries, issues, and escalations raised by client representatives, agents/consultants. Monitor channels for inquiry intake, documenting and managing client representative concerns.

Secures the service deliverables with the account and identifies task and expectations from the client and fulfills deliverables. Reviews the status of the deliverables with the internal teams involved.

Escalate high-priority or high-risk issues to Client Success Lead as needed to determine and carry out resolution.

Develop relationships with clients to understand their goals, processes, procedures and systems to provide support for the relationship with Blue Cross NC. Provides plan/benefit administration support to client. Administer and monitor client contract provisions and maintain compliance with contractual agreements. Addresses client customer concerns and non-compliance contract/administrative issues. Coordinates the required corrective action as identified via data and root cause analysis.

Maintains a collaborative relationship with sales. Reports issues to sales, performs research, identifies issues, and root cause and proposes solutions. Identifies the support area to manage the analysis for root cause issues, as needed. Partner with sales team and cross-organizational support staff to identify and execute solutions for client service requests. Develops and manages documentation that captures issues across the plan, dates for completion and other key deliverables.

Represents Blue Cross NC in critical service-related customer meetings to address issues, or administrative inefficiencies. Participates in customer-facing sales meetings as requested by the sales team.

Delivers client specific reporting, including reporting related to service issues and network disruption, and assists with communication plans. Reviews service-related reporting with clients.

Leverage historic client inquiry and issue data to actively identify future resolution, optimizing inquiry management and issue resolution

Identifies operational inefficiencies and collaborates with Sales team to create a strategy to address. Identify and document best practices and communicate key client issue resolution experiences to suggest process, product delivery, and client service improvement opportunities.

What You Bring

Bachelor's degree or advanced degree (where required)

3+ years of experience in related field

In lieu of degree, 5+ years of experience in related field

Must possess and maintain a valid driver’s license.

Nice to Have

Experience coordinating multiple cases and requests

Large group customer support experience, preferred

Independent worker, confident delivering messages to clients

Strong written and verbal communication skills

If you’re ready to make a career out of making a difference, this is the opportunity for you.We invite you to check out our careers site to see we value diversity and inclusion at all levels of our organization. We have inclusion challenges throughout the year and affinity groups that are an integral part of our culture!It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.Blue Cross NC is a fully taxed, not-for-profit North Carolina company with major operations centers in Durham and Winston-Salem. We employ more than 5,000 people who are passionate about health care, and we serve more than 4.3 million members.Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.E-VerifyOur company uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.Third Party Staffing AgenciesBlue Cross NC does not accept unsolicited resumes from any source other than directly from candidates. For the protection of all parties involved in the recruiting process, resumes will only be accepted from recruiters/agencies if a signed agreement is in place at the inception of the recruiting effort and authorized for a specific position. Unsolicited resumes sent to Blue Cross NC from recruiters/agencies do not constitute any type of relationship between the recruiter/agency and Blue Cross NC and do not obligate Blue Cross NC to pay fees if we hire from those resumes.