Member Service Representative

2 weeks ago

Torrance, United States Amtex System Inc Full time
Job DescriptionJob Description

Summary of essential duties:

  • Provides excellent customer service while responding to customer requests via phone, fax or email

  • Handles member and health plan phone calls with professionalism and courtesy at all times

  • Maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner

  • Advises health plans, members, providers, and Management of progress made towards resolution of member complaints, grievances, and appeals and advices of any problems encountered

  • At all times acts in accordance with all applicable federal, state regulations

  • Accurately and completely documents ALL Member communications, appeals and grievances using Patient Center or other documentation system.

  • Answers incoming calls within standard time-frames on the toll-free and TTY phone lines.

  • Answer incoming calls from Health Providers, Health Plans and members requesting status updates and information on Claims, Authorizations Eligibility

  • Demonstrates excellent telephone etiquette at all times.

  • Transfer incoming calls to appropriate departments when applicable

  • Identifies, researches, and resolves any Member issues/inquiries regarding Claims, Eligibility, Authorizations for Service, etc. promptly and responds to member with complete information.

  • Make outbound calls for follow up on various member matters.

  • Verifies member eligibility as needed and/or requested on individual health plan sites

  • Meets department goals and expectations

  • Attend all mandatory company or department t meetings

  • Documents all department productivity

  • Report to each scheduled shift on time, and commence work and perform essential job function at the start of each scheduled shift

  • Acts as a back-up to the Company’s receptionist as needed and as requested. Will cover reception calls for breaks, lunch, and other times as necessary

  • Actively participates in all staff meetings

  • Collects information, makes decisions, takes appropriate action, and follow tasks through to completion.

  • Assists with Member Outreach Program orientation, events, meetings, etc.

  • Updates excel spreadsheets as needed

 

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