Member Service Representative I

JOB DESCRIPTION

This position is responsible for interacting with members and providers, analyzing inquiries and providing clear and accurate information in a timely manner. This position is also responsible for documenting member contact in appropriate data systems by performing the following duties.

• Provides benefit information in a clear and concise manner.
• Assists members and provider partners with authorizations, assignments, eligibility, claim status and researches inquiries that require additional information not readily available in the internal and external member data systems.
• Documents calls in required data systems in a clear and concise manner.
• Analyzes member and provider inquiries and determines steps for resolution.
• Ensures accuracy of member information and assists members with redetermination processes for continuation of coverage.
• Assists members with benefit coverage questions.
• Conducts appropriate research, follow-up and status updates to members as calls are processed and resolved.
• Relays information to appropriate departments and personnel using established communication procedures.
• Initiates welcome touch point calls to new members.
• Seeks to develop and improve communication skills, conflict resolution, and team effectiveness.
• Enters data in various programs requiring proficient and accurate typing skills.
• Balances multiple tasks utilizing excellent organizational skills and prioritizes necessary steps to accomplish tasks timely and accurately.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
• Respectfully takes direction from manager.

Bi-lingual in Spanish is preferred.

EDUCATION and / or EXPERIENCE

High school diploma or general education degree (GED); and two to four years related experience and / or training; or equivalent combination of education and experience.

COMPUTER SKILLS

Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve / backup important data.

We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.

Background Check & Drug Screen Required