Member Service Rep

1 month ago

Leawood, United States Advantage Tech Full time
ATI is seeking a Member Service Rep to join our OP based cleint. There will be flexibility with hybrid or remote work, but this person must be based in the greater KC area.

This person is responsible for assisting members in understanding their health plan, claim status and answering any questions regarding their benefits, as well as accurately quoting benefits and educating providers of the health plan.

Responsibilites:
  • Provides compassionate and dedicated support to ensure the member experience is in line with company values.
  • Educates and assists members on various elements of benefit plan information.
  • Provides the caller with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, member self-service tools, claims.
  • Triages claims and escalate issues as appropriate through the system for grievances and appeals.
  • Assists members in finding accepting providers and facilities that address their needs.
  • Coordinate with Member Advocate for issues in relation to provider access escalations.
  • Educates and gains acceptance with providers and facilities when they have questions about the health plan.
  • Sets expectations and consistently follows up with communications to the member from ticket initiation to closure.
  • Responds and resolves inquiries on the first call by identifying the topic and type of assistance the caller needs utilizing all resources available.
  • References automated job aid tools via the computer to identify appropriate procedures when needed and research relevant rules, regulations, or procedures.
  • Accurately documents, researches, and resolves all inquiries by ensuring documentation is clear and complete.
  • Meets or exceeds individual and departmental quality standards / achieves performance goals.
  • Adheres to, keeps current on, and utilizes all company guidelines, policies and procedures.
QUALIFICATIONS:
  • The Member Service Representative must be highly motivated and a self-starter and demonstrate reliable attendance.
  • This individual needs to possess strong member service skills, excellent written and verbal communication skills, strong inter-personal and problem-solving skills, convey compassion and be detail oriented.
  • The individual must be able to manage time-sensitive projects and multiple priorities and be comfortable with activities that vary from day-to-day. To perform the position, an individual must be able to satisfactorily perform each essential duty.
EDUCATION AND/OR EXPERIENCE:
  • It is required that individuals have completed a bachelor's degree or have equivalent job experience.
  • Minimum 2 years prior experience with health plans, benefit plans, claims and/or healthcare required.
  • Minimum 2 years of experience in member service in a healthcare environment. Minimum one year experience working in Microsoft Office, specifically Excel, Outlook, Word, and Zendesk.
  • Multilingual preferred but not required.
  • Individuals should have proven experience working in benefits or similar capacity where responsibility included member support, insurance plan education, medical billing and/or scheduling and maintaining working relationships with various partners in the benefits industry.

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