Member Service Representative

4 weeks ago


Étreux, Hauts-de-France, United States Commonwealth Care Alliance Full time
About the Role

The Member Service Representative is a key member of our team, responsible for providing exceptional service to our members. This role requires a high level of empathy, problem-solving skills, and the ability to work in a fast-paced environment.

Key Responsibilities
  • Provide accurate and timely responses to member benefit and health plan questions
  • Respond and effectively triage member phone calls to accurately route to appropriate areas
  • Work with care management teams to address member needs, caregivers, and other constituents
  • Document all member and prospective member interactions in a centralized electronic system
  • Responsible for scheduling member appointments, transportation, translation, and interpretation services
  • Initiate prior authorization intake processes
  • Assist in resolving member billing discrepancies
  • Provide members with requested documents, including provider listings in their areas
  • Complete comprehensive appeal and grievance intakes
  • Collaborate with members to accurately document their appeal or grievance concerns
  • Assist with timely resolution of concerns or complaints conveyed by members and their representatives
  • Conduct research to provide accurate and informed resolutions to member inquiries
  • Collect supporting data and documentation relevant to member care
  • Connect members to their CCA providers through telemedicine accessibility
Requirements
  • Associate's degree or equivalent experience
  • At least six months of recent experience in a call center environment
  • Currently or recently employed in customer service, public service, as a front-line healthcare worker, or in a contact center
  • Experience working with a diverse, differently abled, and elderly population, socioeconomically, ethnically, and culturally
  • Experience working independently while in a team environment
  • Experience working in a quality-focused environment with an emphasis on behavioral-based quality assurance programs
Preferred Qualifications
  • Experience in healthcare, health plans, insurance, or government
  • Prior experience working in healthcare front lines or medical settings
  • Prior experience with service authorizations, grievances, and appeals, scheduling medical appointments
  • Ability to work with multiple computer programs and phone systems at once
What We Offer
  • A dynamic and supportive work environment
  • Opportunities for professional growth and development
  • A competitive salary and benefits package


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