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Member Service Representaive I

2 months ago

Fairfax, United States Three Point Solutions Full time
Job DescriptionJob Description

Job Title: Member Service Rep
Client: Health Care Industry
Duration: 12 months contract role
Location: Fairfax, VA 22031 (100% remote however the resource must reside in District of Columbia, Maryland, Virginia(DMV)

Job Description:

Purpose: The Rep, Member Service I is proficient in routine benefits, claims, and general inquiries. They have a general knowledge of the following: systems, benefits, and contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing, and follow-up to a customer inquiry.

Essential Functions:

  • 25% Answers member inquiries by clarifying desired information; researching, locating, and providing information. Resolves member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
  • 25% Examines claims to identify key elements and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures. Calculates deductibles, maximums, and determining, resolving, reporting, and following through on overpayments, underpayments, and managed care processes.
  • 25% Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other BCBS Plans. Learns the details of offering and administering various billing transactions, i.e., direct pay, credit card payment, and debit accounting through the policyholder's checking account, and how to effectively interact with or advise clients, group administrators, brokers, or providers on problem resolution.
  • 25% Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.

Qualifications:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
  • The requirements listed below are representative of the knowledge, skill, and/or ability required.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level:

  • High School Diploma or GED

Experience:

  • 1 year of customer service, claims experience, Inbound Call Center Experience

Preferred Qualifications:

  • Experience performing duties that are detailed in nature, exposure to health care, health insurance, medical information, and direct service experience is preferred.

Knowledge, Skills, and Abilities (KSAs):

  • Self-starter with strong organizational and planning skills. Proficient
  • Ability to maintain effective interpersonal relationships. Proficient
  • Ability to recognize, analyze, and solve a variety of problems. Proficient
  • Excellent communication skills, both written and verbal. Proficient
  • Maintains quality customer services by following customer service practices; responding to customer inquiries. Proficient
  • The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Additional Skills:

  • Exposure to healthcare
  • Ability to recognize, analyze, and solve a variety of problems.
  • Detailed in nature, exposure to health care, health insurance, medical information, and direct service
#ZRCompany DescriptionAs a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.Company DescriptionAs a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.