Member Service Representative

4 days ago

Albany, United States CDPHP Full time

CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience. The Member Service Representative shall assume full responsibility and ownership for all aspects regarding education of the member, the Employer Groups, Brokers and/or prospective members regarding the proper utilization of the Plan. In addition, the incumbent will address and resolve service problems, complaints, and advise the customer of their rights and responsibilities. The Member Service Representative will work closely with all departments, such as Marketing, Enrollment, Pharmacy (internal and external), Provider Services, and Claims Operations to resolve member inquiries as defined within Member Services Procedures. The incumbent will also review eligibility requirements, provide rates for various health products, provide usual and customary rates based on procedural codes, and assist prospective members with enrollment applications as requested by the customer. Representatives are required to handle multiple product lines, complete system updates and respond to members via telephone and correspondence. QUALIFICATIONS: High school diploma or GED with two (2) years customer relations experience required. Experience with a documentation system to track inquiries generated and received preferred. Strong working knowledge of Microsoft Word required. Demonstrated ability to determine, analyze and solve problems related to benefits, claims processing, claims and benefit appeals/complaints, enrollment and premium billing issues required. Demonstrated ability to successfully apply problem solving and time management methodology, balance multiple tasks as business needs arise while maintaining production and quality standards and meet deadlines. Ability to interpret all CDPHP's health plan contract language, riders, schedules. Demonstrated ability to effectively communicate on a verbal and written basis using appropriate grammar, spelling, punctuation and sentence structure is required with members, providers, marketing, pharmacists, governmental agencies and other persons associated with CDPHP on the phone, written correspondence and/or face-to-face while maintaining a professional approach is required. Strong attention to detail and capability to meet established quality and productivity standards. Ability to complete system updates. As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status. CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC.e, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

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