Member Service Representative; Murray, UT

Position: Member Service Representative (Murray, UT)
Member Service Representative (Murray, UT)

Summary
- This is a call center environment. Call center experience is required. The Member Service Representative responds to incoming telephone calls from client participants and providers regarding Health & Welfare benefits. Each representative will be required to answer approximately 100-125 calls per day.

Essential Duties and Responsibilities include but not limited to

• Positively respond to incoming calls from members and providers by, among other things:
  • explaining group benefits
  • addressing eligibility questions
  • providing information on referrals
  • describing required authorizations for medical care
  • assisting with claims' issues
  • providing claims' status
  • answering questions or concerns
  • resolving problems
• Submit requests for adjustments on claims, research questions and problems, and provide the best solutions available.
• Alternate with co-workers during slow periods to make sure phones are always covered.
• Make outgoing calls to members and providers.
• Alpha sorting, organizing, or other special projects.
• File forms and letters.
• Provide available information upon request and escalate issues as appropriate to Supervisor and/or Manager.
• Retain records of calls by documenting in the appropriate system for tracking.
• Other duties may be assigned.
• Regular and predictable attendance is an essential function of this job.

Member Service Representative Levels

• Level I - Some customer service experience, some claims knowledge, good phone skills, positive attitude, medical knowledge a plus.
• Level II - Level I skills, complete understanding of Bene Sys, Eldorado, Benefit Driven, Well Point, and Envision systems and Plan documents. Not limiting to the above systems, any vendor systems that may be required to assist in calls. Ability to field 90% of calls without consulting the Unit Leader. Prepare appeals for Unit Leader review.
• Level III - Level I and II skills, plus complete understanding of all Plans. Knowledgeable in handling group benefit issues, ability to interpret Plan guidelines. Ability to analyze plans and interpret benefit language contained in Plan documents. Good overall understanding of claims' processing guidelines to assist with resolving claims' issues and able to translate these issues clearly for resolution. Good internal technical ability to assist other Team members with internal/external systems.
  
  Fielding elevated issues from the Team and assessing the problem and attempting to resolve them prior to referring to the Supervisor or Manager.

Qualifications

• Background in medical claims processing.
• Call center experience, required.
• Knowledge of medical terminology and understanding of healthcare benefits, definitions and applications.
• Knowledge of and capable of handling multiple group benefits.
• Ability to communicate clearly with accurate information to callers either by telephone, electronic messaging, or face-to-face interaction.
• Ability to deal with people in stressful situations.
• Ability to use good communication skills and keen observation to understand what a caller is asking for and then use good judgment to come to a resolution.
• Ability to multi-task, respond to questions correctly and accurately and resolve the issue from initial contact with caller.
• Ability to diffuse irate calls to a level where the caller is satisfied with the response and resolution is complete.
• Ability to work well in a team environment and independently.
• Good working knowledge of Microsoft Excel/Word.

Education and/or Experience - High School diploma or GED equivalent. Two (2) plus years in an employee benefits position or similar.

Language Skills - Effective communication skills are essential. Individual should enjoy and be able to work in a busy and sometimes noisy/high pressured environment.

Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication, and division.

Reasoning Ability - Representative must be analytical and can apply common sense to carry out detailed written or oral instructions. Representative must be able to deduce if a balance due is the responsibility of the member or if the plan has yet to consider the charges.

Physical Demands - Occasional lifting of paperwork and batches of claims. Regular use of standard office equipment (computers, phones, photocopiers, fax machines, etc.). Sustained periods of being on the telephone, keyboarding, sitting/standing.

Work Environment - The position operates in a typical call center environment, at times can be noisy, pressured and stressful. The department can be fast paced.

Work Schedule - Full time. Monday - Friday, 8:30am - 5:00pm. Required in office (no at-home days).

Competitive Benefits & Compensation Package

• Paid Time Off (PTO)
  • 15 days of PTO during first full calendar year!
• Medical, dental, vision, and life insurance
• Company-paid basic life, short-term disability, long-term disability, and AD&D insurances
• 401k with employer match
• Tuition reimbursement program
• Career development opportunities
• Referral bonus for all successful…