member services representative

manager

customer service representative

actuary

analyst

Blue Cross Blue Shield of Massachusetts

•	Currently working for IBM for past 5 years.
•	Successful Business Analyst with Extensive Project Management and Business Analysis Experience
•	8 + years of diversified experience as Software Business Analyst, Project Lead, Quality Assurance and Mainframe Development.
•	Have good knowledge in various industry domains like Healthcare and Automotive Domain.
•	Excellent in working with the clients, understanding business needs ,documenting solutions and presenting business solutions to the team.
•	Over 2 years of experience in managing projects, doing feasibility studies, accumulating requirements, developing work scopes, time and cost.
•	Experience in gathering user requirements, analyzing and preparing Project Deliverables such as Business Requirement Document (BRD), Functional Specification Document (FSD), data mapping and use cases.
•	Adept at coordinating with stakeholders, Subject Matter Experts (SMEs) and end users to understand, analyze, communicate and validate requirements through User interviews and Joint Application Design  (JAD).
•	Proficient in transforming business requirements into functional specifications focusing on workflow analysis and design, user interface design, business process reengineering and process flow modeling.
•	Expertise in understanding the business needs, defining a creative and useful software solution to the management, implementing and training the application to the user community.
•	Understanding HIPAA 835, 837, 270, 271, 276, 277 and 278 transaction types.
•	Understanding of ICD9 to ICD10 conversion.
•	Demonstrated ability to work efficiently in different phases of Software Development Life Cycle (SDLC).
•	Good understanding of different software methodologies like Waterfall, Rational Unified Process (RUP) and Agile methodologies (SCRUM).
•	Experience in writing test plans, reviewing test cases and coordinating QA teams.
•	In-depth knowledge of conducting User Acceptance Test (UAT), data quality checks using SQL, gap analysis and Requirement Traceability.
•	Excellent working experience with SQL.
•	Expertise in writing Business Requirement Document (BRD), Functional Requirement Document (FRD), System Requirement Specification (SRS)
•	Thorough knowledge in UML Modeling, including Activity Diagram, Sequence Diagram, Use Cases, State Chart Diagram ,Deployment Diagram, Class Diagram, and Component Diagram
•	Have extensive knowledge in Data flow modeling and Object modeling, case analysis and functional decomposition analysis
•	Lead efforts with business partners and technical teams to perform analysis, define requirements, and present innovative solutions that solve business problems, or that meet business project and service request needs.
•	Gather and translate business requirements and work with technical staff to translate tactical business requirements into functional requirements, thus driving technical improvements, enhancements, and/or creation of new applications.
•	Proficient at drawing Business Process Diagram, Workflow Diagram.
•	Possesses good knowledge of testing methodologies SDLC and STLC. 
•	Have sound understanding on Healthcare claims processing and adjudication 
•	Possesses excellent knowledge of Mainframe technologies and NASCO
•	Have sound knowledge of HP Quality Center and Clear Quest 
•	Good in Defect debug, troubleshoot impact and gap analysis, coordinating issue resolution among the stake holders and handling the Defect Triage calls
•	Have good exposure to the Risk management and baselining all testing policies with quality assurance, policies and standard
•	Created Test Plans, Test Cases, Test Procedures and Test Script.
•	Strong expertise in establishing QA policies, procedures, strategies and developing appropriate process to ensure the quality of product.
•	Good at web technologies like HTML and XML.
•	Good in Mainframe Technologies like Cobol , JCL , DB2 , CICS , IMS DB and Syncsort.
•	Experienced in creating Requirement Traceability Matrix to ensure comprehensive test coverage of requirements.
•	experience in Manual Testing on Mainframe using HP Quality Center.
•	Knowledge of Defect/Bug tracking system with the use of tools like HP Quality Center and Bugzilla.
•	Strong working experience in various databases such as DB2, MySQL, SQL Server and MS Access.
•	Excellent Analytical, Decision-Making and Organizational Skills coupled with good co-ordination, communication and interpersonal skills describing a committed Team Player with an ability to handle/organize multiple projects simultaneously.
•	Well versed with White box & Black box testing techniques.
•	Experienced in Manual testing with the focus on Functional Testing, Integration testing, Stress Testing, Regression Testing, Smoke Testing, Load Testing, System Testing, GUI testing and Unit Testing in different stages of QA process.
•	Proficient in RPM and RTC IBM Project Quality Tracking tools.
•	Experienced in working with business analysts, development groups in analyzing business specifications and in working with other testers to resolve technical and end-user issues.

BCBSMA is a wonderful company to work for. I was a member service representative - the person you talked to when you called with an issue.

Training is structured so that you only go on the phones when you know the material, and there's plenty of support throughout. Once you're through training the management and other co-workers are all incredibly supportive, assisting with difficult calls.

Unfortunately this is a very stressful position and I had to leave when I literally could not take being yelled at any longer. A typical call isn't long or overly stressful, but at least once a day you'll experience a member blaming you for their problems even as you try your hardest to help them. The next call might be praise for the smallest bit of information. The constant flux of emotions meant that this wasn't the job for me and may not be for you.

Benefits were good and not horribly expensive. BCBSMA still participates in a 401K, which I found to be very helpful. Unfortunately the actual pay started under 30K, which I found to be inadequate considering the scope of work and the toll it takes. The management I spoke to agreed that the position should be paid more as it is essential to the success of the business, but when I left the upper management hadn't seemed to have paid much attention to my manager's request for a higher starting pay.

Overall this is a great company with many job opportunities in a variety of fields. Employees are treated well with clean work environments and wonderful cafeterias, and everyone is truly friendly.

I worked at BCBSMA from 2007-2013 and I saw a slow decline in the level of cooperation and teamwork across most of the divisions I interacted with on a daily basis. The biggest culprit to why this negative transition occured was our slow decline in membership. To shake things up and try to improve the overall company, senior leadership was changed. The leaders all seemed to come from the same 2-3 organizations and their people skills and human touch were completely lacking in all areas of management. Ironically they did not come from a sales background or seem to even care about membership growth or interacting with people to build bridges. I specifically was astounded to see so many come from a disease management firm and then hire their friends to work for them. In the end half of my department was re-structured and without regard to skill set and potential for contributing in other areas of the division, people were let go. This is not an indictment on the company for laying me off; I have worked for 25 years for various small and large companies and seen many changes in the corporate culture of the insurance industry and the financial sector. The problem is the "trickle-down effect". If the senior executives are disinterested in getting to know the middle-managers (or those in the trenches), and do nothing to improve sales, I see no way the company as a whole will improve. In the time since I found a new job, I have heard this story told over and over at BCBSMA. It is a shame because I loved working there for the most part and were surrounded by very intelligent, hard working people.

This job starts with 2 months of intense training, it feels like you’re in school with worksheets and a lot of group work. In order to pass on to working on the phones, you must pass an exam at the end (which is pretty easy, everyone in my training class passed).

Being on the actual phones can be really overwhelming because there’s so much information to learn that it’s impossible to learn/remember everything from training. It’s great when the customer is nice, but if you’re sensitive, it’s really hard when a customer is angry or just doesn’t want to listen. 

I think the job pays pretty well, but it’s hard to work your way out of the call center. Plus, taking calls all day can be really draining and you don’t really get any breaks. If you take more than 5 minutes to use the restroom, your manager will most likely call you to “check in” (meaning you were off the phone for too long). Most people on the help hotline are super helpful and kind, but there are also some employees who are condescending, which is tough when you’re just starting out and the job is overwhelming. 

I would go over Members benefits
Review claims 
• Investigate and resolve member inquiries through correspondence and computer research
• Advise customers regarding policy and benefit information for multiple health plans
• Coordinate internal activities necessary to research and resolve inquiries and provide accounts with service solutions
• Contribute to a team effort to meet or exceed service, production and quality goals
• Identify errors and implement solutions with team members and leaders
• Meet and exceed daily, weekly and monthly performance goals
• Provide a high level of service to both external and internal customers
• Creative problem solving within a team environment
• Created a caring atmosphere for customers

• Flexibility and willingness to change as business needs change within the division
• Take ownership of work as you work Day to Day from Home Self-Management 
• See opportunity in the unexpected
Review Members /Dental/ Claims/ RX bens/ connect the to COB

The call center representatives answer hundreds of calls per week, and they advise providers regarding patient benefits and eligibility as well as adjudicating claims. Appeals were also received via email applications and by mail. Constant changes in the business, and passage of new laws will always provide learning opportunities so the old saying you learn something new everyday certainly applies. Management emphasizes quantity of work more than quality, however, so reviews are all about where your work compares to the set goals, for example the number of calls one receives and how long the call takes. Management also see their associates more of tools rather than the assets they really are. Do not expect to implement any sort of lasting changes or improvements. Your ideas will be heard and then promptly ignored.

Customer/Member Service Position, on phones.
PROS: excellent benefits, remote work option, remote training, very nice colleagues
CONS: relentless calls always busy, rude customers, info keeps changing making it impossible to keep up, metrics are annoying and out of your control, no control over schedule, pay is way too low for the level of stress, you'll be trapped in same position for at least 2.5 to 3 years (even though they tell you otherwise.) They promote based on friendship/nepotism/cliques and not  on ability, education or metrics.

If you LOVE phone calls and customer service, definitely apply! Stable company and all equpment is provided.

If you hate phones and emotional customers, do not apply. You'll be miserable. (People cry before, during and after work, in this position.)

People who work in other parts of this company do love their roles and stay long-term. It's the phone roles that are rough. Customers really have grown worse over the years.

My typical day began at 4;30 am.I was out of my house and on the road by 5;15am. My drive to Boston on a good day took about 45 minutes. But, sometimes it could take 90 minutes or more depending on the traffic.
I would use this time to formulate my day or week. Once I got to the office it was right to work for me. I had so much time that I spent solving clients specific problems, following up with various department etc. Then it was on to renewal, setting up appointments, putting together renewal kits, working on strategy's with various underwriters and getting special exceptions from management from various departments for my specific cases that might need them. I would usually spend the lunch hour documenting and filing data for future reference.
My afternoons were set for appointment I was usually able to get 2 visits in per day if I was lucky and depending upon travel time and the complexity of the account.

What is the best part of working at the company?
The projects are engaging and the work is fast paced. There is a lot of collaboration. 

What is the most stressful part about working at the company?
Too many senior staff that are legacy employees, they have their favorites. These people always get promoted and/or get the best projects to work on. Their is a lot of nepotism and office politics. 

What is the work environment and culture like at the company?
They try to pretend they have culture that is based on inclusivity, they’ll throw all the right buzz words around but at the end of the day you realize they don’t understand the concepts and how to implement it in a meaningful way. 

What is a typical day like for you at the company?
Lot of meetings. Lot of laughs. Its a fun place. But again, most - no matter how hard they work and no matter how excellent their results are will not thrive, move up or develop their careers.

BCBSMA is one of the best companies to work for as long as you know what you want to do. In Member Services it is an entry level position, and a great way to get in the door to working at BCBSMA. On a typical day you take 30-45 calls, and get all types of questions about member benefits, or administrative requests like sending documents or help with website or app accounts. 

The hardest part of the job is when our customers are unhappy, and there is an issue that is out of our hands. This does not happen every call, but there are some times when you cannot get something done without third party cooperation (i.e doctors, hospitals, etc).

The most enjoyable part of the job is when you successfully answer a request or help your member gain understanding of your plan. 

Member Services is great for people who enjoy teaching, small talk, and are okay with a mostly sedentary job.

Top Job Titles	Average Salary
Member services representative 3 salaries reported	$20.67 per hour
Manager 13 salaries reported	$102,000 per year
Customer service representative 3 salaries reported	$52,333 per year
Actuary 6 salaries reported	$97,250 per year
Analyst 8 salaries reported	$79,125 per year

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