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Member Services Representative

2 months ago

Syracuse, United States Nascentia Health Full time

The Member Services Representative is responsible for managing incoming calls and customer service inquiries, including identifying and assessing customers' needs with the goal to achieve one-call resolution and satisfaction to the best of their abilities. As a Member Services representative the candidate will be working in Nascentia Health's Communication Center, a high-volume call center for all lines of business. Duties include:

Performance Responsibilities and Standards:

  1. Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment, and explanation of benefits (EOBs, etc.)
  2. Review inquiries, correspondence, and email receipts. Prepare resolution tickets, email resolutions, letters, and/or claims payment process adjustments
  3. Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
  4. Review and research incoming healthcare claims from members and providers by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
  5. Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, State (DOH) mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
  6. Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
  7. Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with other departments and with the member
  8. Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance
  9. Ability to support and interface with a wide cross section of internal and external audiences with varying levels of experience
  10. Participates in special projects as required
  11. Other duties as assigned
Requirements
  1. 1+ years prior experience in customer service, call center setting or phone support role
  2. Health insurance experience
  3. Knowledge of HIPAA, DOH, and CMS regulations for insurance plans
  4. Strong interpersonal, communication, and problem-solving skills
  5. Meet personal and communication center team goals and call handling quotas
  6. Provide backup to other areas of the Communication Center as needed
  7. Basic working knowledge of, and experience using a wide variety of software platforms including Microsoft Office Suite (Outlook, Word, Excel and PowerPoint)
  8. Knowledge of telephone system technology
  9. Must ensure compliance with all regulatory, audit and corporate policies
  10. Professional appearance and dress

Physical Requirements
  • Ability to sit or stand at a desk 90% of the day
  • Visual/hearing ability sufficient to comprehend written or verbal communication
  • Ability to express self verbally and in writing
  • Ability to use telephone and communicate over the phone
  • Frequently uses a laptop computer to enter orders and obtain product information
  • Bloodborne Pathogens Exposure Category III - Employee who rarely has contact with blood and body fluids
Compensation & Benefits

Competitive Salary [This position is an H05 non-exempt position with a min-max rate of: $17.09-$25.64/hour]with:
  • Retention bonuses
  • 401k with generous Employer match
  • Medical, Dental, Vision plans
  • Tuition Reimbursement for BSN after 6 months of employment
  • Exceptional work/life balance - no rotating shifts, holidays or weekends
  • Partially funded HSA
  • Employee Recognition Platform
  • Paid Time Off, Holidays, and Extended Sick Leave
  • Short/Long term Disability
  • Employee Assistance Program (EAP)
  • Much More


About Nascentia Health:

Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.

Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.

Nascentia Health is an Equal Opportunity Employer (EOE)

Employment is contingent upon negative results of a pre-hire drug screen