Blue Cross and Blue Shield of Nebraska

• Responsible for meeting all State and Federal regulations • Responsible for accurate and timely medical review of claims and preauthorization's • Responsible for accurate and timely medical review of Customer Service inquiries about claims and preauthorization's • Responsible for determining availability of benefits according to company contracts, endorsements and medical policy • Responsible for determining member eligibility prior to medical review • Responsible for fostering a constructive relationship with all departments within BCBSNE • Responsible for maintaining professional licensure and practicing within the scope of licensure • Responsible for collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists

• Responsible for adhering to all State and Federal regulations as well as BCBSA, BCBSNE, Medicare Advantage and Federal Employee Health (FEP) mandates related to the formal appeal resolution of claims, precertification and preauthorization processing. • Responsible for accurate and timely medical review of appeal requests and the formal appeal resolution of claims, pre-certifications and pre-authorizations. • Responsible for accurate and timely medical review of Customer Service inquiries associated to appeals and related claims, pre-certifications and pre-authorizations. • Responsible for completion of special projects. • Responsible for determining availability of benefits according to Medicare Advantage, company contracts, endorsements, criteria and medical policy. • Responsible for determining member eligibility prior to an appeal medical review. • Responsible for fostering a constructive relationship with all departments within BCBSNE. • Responsible for maintaining professional licensure and practicing within the scope of licensure. • Responsible collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists to ensure medically appropriate, high quality, cost-effective care, promote positive member outcomes, effective use of resources, optimize member benefits, and support business initiatives. • Weekend Coverage Rotation: Approx every 6-8 weeks, working 8 hours.

• Handle incoming phone calls and be the primary customer interface for inquiries. • Inform and educate customers and serve as member advocate. • Use established best practices, attend ongoing training and utilize resources to navigate insurance. • Research customer information utilizing appropriate systems to effectively respond to and resolve issues. • Comply with State and Federal regulations and stay current on policies to support customers.

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. As a Customer Service Representative you are responsible for handling incoming phone calls and being the primary customer interface for inquiries. Our service representatives inform and educate as well as serve as member advocate, building trust in our abilities and being the voice of the customer. By using established best practices, attending ongoing training and utilizing resources and tools you will serve as the expert to help navigate through the challenging world of insurance. Our representatives must be talented dedicated people who possess a passion for providing best in class service and want to make a difference in the lives of our member. - Candidates applying to this position must reside within the state of Nebraska or immediate Omaha metro at the time of application. - Candidate must have distraction free environment in order to take back-to-back calls throughout the day and possess high speed internet. - Pay for this position is an annual salary of $42,640 - Training for this position is remote and lasts approximately 9-12 weeks long (Monday - Friday from 8:00am - 4:30pm CST). - After training is completed - all employees must be able to work any 8.5-hour shift Monday - Friday within the hours of 7:30am - 6:00pm CST. Customer Services hires for classes and we anticipated class start dates: - Summer 2026 & Fall 2026 **This is an evergreen role. Candidates will not receive immediate feedback, and applications will be reviewed as future classes are confirmed. The BCBSNE Talent Team will contact candidates whose experience aligns with upcoming needs.** What you'll do: - Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail. - Research customer information utilizing appropriate systems, policies, regulations, procedures and other reference materials to effectively respond to and resolve customer issues. - Elevates sensitive customer requests when necessary. - Comply with State and Federal regulations and mandates, which are continually changing, thus creating a very dynamic environment, candidate is responsible to take initiative to stay current on policies and procedures required to support the customer and to ensure compliance. - Accountable to remain current on knowledge of diverse products and proactively recommend items needed by customers to increase customer satisfaction and improve transaction profitability. To be considered for this position, you must have: - High School Diploma or Equivalent and three years of experience in a complaint type customer service office setting (health insurance or related field preferred). An equivalent combination of education and experience may be substituted for this requirement. - Availability for training 14 to 16 weeks in length. The strongest candidates for this position will also possess: - Basic medical/dental terminology and contract interpretation is a plus. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. As a Customer Service Representative you are responsible for handling incoming phone calls and being the primary customer interface for inquiries. Our service representatives inform and educate as well as serve as member advocate, building trust in our abilities and being the voice of the customer. By using established best practices, attending ongoing training and utilizing resources and tools you will serve as the expert to help navigate through the challenging world of insurance. Our representatives must be talented dedicated people who possess a passion for providing best in class service and want to make a difference in the lives of our member. What you'll do: - Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail. - Research customer information utilizing appropriate systems, policies, regulations, procedures and other reference materials to effectively respond to and resolve customer issues. - Elevates sensitive customer requests when necessary. - Comply with State and Federal regulations and mandates, which are continually changing, thus creating a very dynamic environment, candidate is responsible to take initiative to stay current on policies and procedures required to support the customer and to ensure compliance. - Accountable to remain current on knowledge of diverse products and proactively recommend items needed by customers to increase customer satisfaction and improve transaction profitability. To be considered for this position, you must have: - High School Diploma or Equivalent and three years of experience in a complaint type customer service office setting (health insurance or related field preferred). An equivalent combination of education and experience may be substituted for this requirement. - Availability for training 14 to 16 weeks in length. The strongest candidates for this position will also possess: - Basic medical/dental terminology and contract interpretation is a plus. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The ideal candidate will live within the state of Nebraska or Local Omaha area. If living in one of our approved states (Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas). Responsible for ensuring the Customer Service Center operates in the most efficient manner possible by providing accurate forecasting, scheduling to meet staffing needs and distribution of skilled resources to meet service goals. Responsible for reporting and analysis of multi-channel traffic to identify trends and monitor performance. Provide company leaders with efficiency updates and uphold high customer service standards through real-time monitoring and other methods. What you'll do: - Responsible for the development and maintenance of contact center operations reporting to include individual, team, center and enterprise statistics. - Maintains accurate quantitative and qualitative records of multi-channel performance and client service levels (performance guarantees). - Assist with scheduling and process time of requests. - Assists in the manpower planning process, especially in the areas of staffing (permanent headcount) and scheduling (situational headcount). - Monitors and measures contact center volumes and performance of Contact Center Operations to assure the highest effort of productivity. - Monitors real-time traffic patterns, daily production reports and work volume making appropriate staffing adjustments to meet fluctuating workload and measurable service objectives. - Utilizing software, researches and analyzes historic records of traffic and performance to identify trends and patterns resulting in accurate forecasts. - Conducts periodic training sessions instructing various contact center personnel of workforce management methodologies and technology. - Collect, identify, review and analyze workforce data to make data driven decisions and constructs proactive recommendations towards meeting measurable service objectives. - Maintains working knowledge of Automatic Call Distribution system to make sound operational decisions. - Manage agent skilling and proficiency settings as well as call type prioritization. - Lead meetings that will focus discussion about WFM KPIs, resource challenges and skilling or servicing strategies. - Hours: Call Center hours are Monday–Friday, 7:30 a.m.–6:00 p.m. Team members rotate schedules to meet coverage needs. Assigned workdays and hours will be determined once an offer is accepted. To be considered for this position, you must have: - Bachelor's Degree or equivalent and relevant Workforce Management experience. - 1+ years of experience administering a WFM system inclusive of forecasting, scheduling, and real-time functionality that is generally native to a WFM system. - 1+ years of experience administering agent skilling. - Excellent Microsoft Excel skills - Excellent communication skills and ability to effectively communicate with all levels within the organization (verbal and written). - Working knowledge of Excel, to include workbook design, data accumulation and reporting. - Understanding of Call Center. - Telecommunications including call routing and skill management. - Superior attention to detail, innovation and strong business acumen. - Experience in responding effectively to highly sensitive, complex and/or urgent requests. - Effective organizational, planning and time-management skills. - Effective analytical thinking and ability to clearly identify key elements, patterns, results and relationships. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The ideal candidate will live within driving distance of the Omaha, Nebraska office. This position allows remote flexibility but may have in-office collaboration and meetings. If living in one of our approved states (Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas) – this person may travel to our headquarters. This position is responsible for reviewing and researching all findings from our Payment Integrity (PI) vendors and driving awareness to mitigate future claim overpayments. The individual will reconcile PI vendor monthly billing by maintaining accurate records of all PI vendor accounts, investigate new data mining overpayment concepts for our internal PI team, and recover overpayments that cannot be offset by providers and/or members via outreach communications. In addition, this person will be responsible for quantifying and validating prepay and post pay claims for BCBSA InterPlan and will invoice for vendor fees of PI activities BCBSNE performs for other host Blues Plans. What you'll do: - Works closely with PI vendors and internal business partners to respond to inquiries and determine opportunities to ensure mitigation of future overpayments. - Analyzes individual vendor files, sends approved overpayments to appropriate adjustment areas and researches any discrepancies between what was identified and the adjustments. - Reconciles all PI vendor bill submissions to ensure accuracy and avoid duplicate payments. Maintains files of all identified PI vendors to ensure claims have been adjusted and money has been recuperated. - Audits internal data mining concepts to identify and recover overpayments. Research and completes outreach to providers/members to communicate and obtain manual overpayment refunds that cannot be systematically recovered. - Provides timely and accurate investigation of potential overpaid claims identified by recovery vendors. - Compiles, reconciles, and validates all prepay and post pay PI activities performed on Host claims on a regular cadence to invoice for PI vendor fees. Works closely with BlueCard claims operations and finance for invoice submissions and appeals. - Research and respond to internal questions relating to claim overpayments and refund activity. Documents recovery procedures. - Completes special projects, assists with audit requests. To be considered for this position, you must have: - High School Diploma or equivalent and two (3) years of experience in a health insurance field. An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments. The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. The strongest candidates for this position will also possess: - One (1) year refund, Payment Integrity, and/or auditing experience. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

• Handle incoming phone calls and serve as the primary customer interface for inquiries • Inform and educate members, building trust and being the voice of the customer • Utilize established best practices and ongoing training to help customers navigate insurance processes

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Senior HR Generalist is a versatile, experienced HR professional responsible for delivering advanced HR support and guidance across all areas of Human Resources. This role encompasses higher-level duties, with a primary focus on Talent Acquisition to include technology recruitment. The role may potentially include complex employee relations, project leadership, full cycle recruiting, and cross-functional collaboration. The Senior HR Generalist may be assigned work from any HR discipline and is expected to assist centers of excellence and mentor other HR team members. - Manage the full recruitment lifecycle, including job postings, sourcing, screening, interviewing, and extending offers for all technology roles and additional roles assigned throughout the organization. - Act as candidate advocate and consultant to the hiring manager. - Negotiate offers by partnering with hiring manager, senior management, and others as necessary. - Lead the proactive forming of talent pipelines for high skill/high demand positions by identifying and cultivating relationships with passive talent and acting as a brand ambassador for BCBSNE. - Partner with HR business partners, talent development team, and company leadership to anticipate upcoming positions due to skill gaps, attrition, retirements, or future talent needs. - Develop and implement innovative sourcing strategies to attract high-potential candidates, utilizing various channels such as social media, job boards, university relations, networking events, and employee referrals. - Provide front-line leadership support, consulting with managers and employees on complex HR matters based on the area assigned (e.g., employee relations, benefits, compensation, or recruitment). - Lead or support advanced HR projects, which may include performance management, merit processes, job description development, full cycle recruitment, and organizational initiatives. - Manage sourcing, onboarding, and offboarding processes for employees and contractors as assigned. - Administer and optimize HR systems (e.g., LMS, HRIS), troubleshoot issues, and collaborate on system enhancements for your assigned area/s. - Conduct and analyze compensation, job leveling, and pay practices, partnering with department leaders. - Facilitate documentation and process improvements for cross-training and operational efficiency. - Serve as a resource for centers of excellence, supporting specialized HR functions as needed. - Generate and interpret reports from HR systems to inform decision-making and strategy. - Ensure compliance with HR policies and procedures and contribute to policy development and employee investigations as applicable. Qualifications - Bachelor’s degree in Human Resources or related field, or equivalent experience. - 3+ years of progressive HR experience, including employee relations, talent acquisition, project leadership, or related experience, based on area of assignment. - Advanced communication and interpersonal skills; ability to consult and influence at all levels. - Proven ability to handle complex issues and make decisions with broader organizational impact. - Experience with HR systems (e.g., ATS, LMS, HRIS) required. - An equivalent combination of education and experience may be substituted for this requirement. - The ability to meet or exceed the attendance and timeliness requirements of their departments. - The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers. Requirements - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. - Reasonable accommodations may be made to enable

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Customer Service Representative, you are responsible for handling incoming phone calls and being the primary customer interface for inquiries. Our service representatives inform and educate as well as serve as member advocates, building trust in our abilities and being the voice of the customer. By using established best practices, attending ongoing training, and utilizing resources and tools, you will serve as the expert to help navigate through the challenging world of insurance. - Interface with customers via telephone, written correspondence, fax, web, and/or electronic mail. - Research customer information utilizing appropriate systems, policies, regulations, procedures, and other reference materials to effectively respond to and resolve customer issues. - Elevate sensitive customer requests when necessary. - Comply with State and Federal regulations and mandates, which are continually changing. - Remain current on knowledge of diverse products and proactively recommend items needed by customers to increase customer satisfaction and improve transaction profitability. Qualifications - High School Diploma or Equivalent - Three years of experience in a complaint-type customer service office setting (health insurance or related field preferred) - An equivalent combination of education and experience may be substituted for this requirement. - Availability for training 14 to 16 weeks in length. Requirements - Reliable internet service provider - Dedicated, distraction-free workplace Benefits - Salary: $42,640 annually + benefits package (Health Benefits effective 1st of the month following start date) - Full-Time (40 hours per week) - 9-12 weeks of live virtual training: 8:00am – 4:30pm (Central Time Zone) Monday to Friday - Must be able to work any 8.5 hour shift between 7:30am-6:00pm (Central Time Zone) Monday to Friday after training