Health Member Services Specialist

Job Description

Job Description

POSITION SUMMARY

Answer inquiries, resolve issues, and handle customer (internal and external) concerns while maintaining a professional image through superb telephone etiquette and excellent customer service. Serve as a key member of a cross-functional team responsible for incoming and outgoing customer services for members, consultants, and others as related to Everence health products.

RESPONSIBILITIES AND DUTIES

• Answer inquiries regarding eligibility and confirmation of benefits for coverage of proposed services.
• Answer inquiries regarding the status of claims payment for all Everence health products.
• Research and assist in resolving all issues coming into the call center.
• Work with the cancelation of a policy and strive to retain membership.
• Provide coverage options for Medicare Supplement products including pricing.
• Maintain an understanding of Everence third-party administration products and services; Medicare and Medicare Supplement plans; Medicaid; corporate policies, and product-specific policies; procedures and business rules for the above-named products.
• Provide appropriate written correspondence to members and providers.
• Document all customer service contacts.
• Perform other duties and assignments as requested by the Health Member Services Manager.

QUALIFICATIONS

Experience : High school graduate

Skills and Abilities :

SUPERVISORY RESPONSIBILITIES : None

SCHEDULE : Full-time