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Member Services Representative

2 months ago

Menasha WI United States TEKsystems Full time

Description:

The Member Experience Representative’s primary focus is to answer phone, or email inquiries from providers, members, customers or brokers regarding questions of coverage, claim status, benefit interpretation, billing and/or authorizations.

Proficient in one line of business, either Medicare or Group/Marketplace, translating health care related jargon into effective written or verbal communication for the end user to comprehend.

Document details of the interaction within the database, including any additional action steps taken as follow up.

Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health

Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies

Answer incoming phone calls from members, customers, providers or brokers efficiently regarding their inquiries on coverage, claim status, benefit interpretation, billing and/or authorizations. Respond to inquiries within set timeframes to adhere to department metrics and contractual standards.

During telephone call, probe and ask appropriate questions to identify specifics of what caller is inquiring about to ensure first call resolution.

Follow-up with customers or other departments on any outstanding issues or concerns. Escalate appropriate issues to Supervisor or appropriate individual.

Additional Details:

Support our members by answering calls and proactively work to resolve our members questions and concerns.

Strive for first call resolution, working to resolve member issues at the point of contact.

Use dual monitors while leveraging computer-based resources to find answers to customers questions and help simplify next steps for members.

You may reach out to internal departments or external resources to help resolve a member concern.

We provide a continuous learning environment where you can learn and stay current with our plans, computer systems, and insurance trends.

You will have the ultimate responsibility of protecting the personal health information of our members.

Skills:

customer service, insurance, medicare, group insurance, Managed Care, Health Plan, Data entry, Claim, Microsoft Office

Top Skills Details:

customer service,insurance,medicare,group insurance

Pay: 17.25-18.50

Additional Skills & Qualifications:

Minimum Related Years of Experience (per minimum education) Required:

Experience working in a customer service focused industry strongly desired.

Experience working in a call center preferred.

Knowledge of basic insurance concepts preferred.

Cultural:

Strong oral and written communication skills with the ability to listen mindfully, identify gaps and ask appropriate questions

Ability to organize one’s work and space to ensure successful completion of assigned tasks within the identified timeframe

Ability to adapt to new circumstances, information and challenges in a fast paced environment

Ability to work independently, as well as part of a team

Strong conflict management skills, with the ability to resolve and deescalate situations solving customers or members concerns while maintaining service excellence standards.

Functional (job specific-at least three and no more than 10):

Ability to work in a fast-paced environment with the ability to handle constant volume of phone inquiries or email messages.

Capacity to multi-task by using navigating multiple computer application and programs simultaneously.

Intermediate skills in Microsoft Office, including Outlook, Excel, and Word.

Comprehend and educate members on multiple lines of business for their inquiries

Experience Level:

Entry Level

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.