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Member Services Representative

2 months ago

Concord CA, United States TEKsystems Careers Full time

*Description:* Duties and Responsibilities:

  • Performs various duties and responsibilities of Member Services Assistant and Member Services Assistant Lead.
  • Communicates via telephone, in person and written correspondence, answers questions regarding the Plans' Benefits, eligibility, claims processing and claims appeal
  • Obtains all pertinent information to determine specific purpose of call and/or walk-in.
  • Writes an eligibility appeal, sick leave and/or basic medical appeal if necessary.
  • Initiates and prepares correspondence and other documentation to resolve questions and provide information to members and others in accordance with Plans' rules, regulations, and practices.
  • Initiates and reviews various applications, notices, forms, certifications, self-payments, COBRA, stop payments, clear claim notices.
  • Identifies and corrects information on Computer system and/or refers to appropriate staff for correction.
  • Determines eligibility in accordance with Plan rules and resolves eligibility issues and questions. Confirms or denies coverage based on eligibility rules of the member’s plan.
  • Maintains appropriate documentation of all calls & walk-ins.
  • Handles walk-ins in a courteous and professional manner.
  • Discerns needs and verifies forms from a walk-in and refers to appropriate personnel based on needs.
  • Acts as liaison between member and provider to communicate plan benefits and facilitate claims processing.
  • Calculates sick leave banks.
  • Refers calls, members, union locals, and others to appropriate department.
  • Assists with special projects as requested.
*Experience Level:* Entry Level Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. This temporary role may be eligible for the following:
  • Medical, dental & vision
  • 401(k)/Roth
  • Insurance (Basic/Supplemental Life & AD&D)
  • Short and long-term disability
  • Health & Dependent Care Spending Accounts (HSA & DCFSA)
  • Transportation benefits
  • Employee Assistance Program
  • Time Off/Leave (PTO, Vacation or Sick Leave)
About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.