Healthcare Service Representative; Troy, MI

Position: Healthcare Service Representative (Troy, MI)
Healthcare Service Representative (Troy, MI)

Summary
- This is a fast paced, call center environment. The primary responsibilities in this position are to answer participant and dependent phone calls regarding eligibility and enrollment as well as determine, maintain and terminate member and/or dependent eligibility for health care and benefits.

Essential Duties and Responsibilities include but not limited to

• Answer participant calls, mail participant requests and resolve participant issues.
• Know the plan rules for eligibility as outlined in the Summary Plan Description (SPD) for each fund.
• Assist members and their dependents with all issues regarding eligibility for benefits.
• Explain eligibility rules to members.
• Send proper enrollment documents to members adding children or a spouse.
• Enrollment verifications.
• Death Notifications.
• Communicate with various vendors regarding prior authorizations and eligibility issues.
• Comment system when changes are made to Participant record or when Participant calls with request.
• Knowledgeable of policies, procedures and coverage of various funds.
• Assist callers with questions regarding deductibles, out of pocket accumulators, dental, vision and medical benefits, MRA or Bennycard and short-term disability inquiries.
• Status medical, dental and vision claims for members and some providers.
• Maintain records of all interactions with members/providers.
• Make outgoing calls to members, providers, collection agencies and vendors such as BCBSMI, HAP to resolve claim or eligibility issues.
• Follow up with members to ensure any issues are resolved.
• Request check tracers.
• Enter change of address notifications.
• Submit escalations to management for complex calls for assistance.
• Regular and predictable attendance is an essential function of this job.

Qualifications - Excellent customer service skills are a must. Proficient in the use of Word, Outlook and Excel.

Preferred Qualification - Spanish speaking.

Education and/or Experience - Post-High School education or prior related work experience preferred.

Language Skills - Good oral and written communication skills. Ability to read and interpret eligibility rules as outlined in the SPD, user manuals for on-line services, department rules and procedures manual, COBRA Compliance manual. Ability to speak clearly and effectively explain to members, dependents, providers and union officials the month-to-month eligibility rules and requirements for coverage.

Mathematical Skills - General math skills with the ability to calculate hours and rates to determine self-payments and hour banks.

Reasoning Ability - Must be capable of thoroughly analyzing vendor invoices and all month-end reports, find discrepancies in member's eligibility, make necessary corrections based on department procedures, understand Plan rules and analysis of member's eligibility.

Physical Demands - Must be able to sit for up to eight hours each day answering incoming calls and preparing various correspondence using a variety of office equipment. Must be able to stand for one-to-three-hour intervals while completing filing tasks, organizing department fulfillment center, standing at copy machines to make packages. Occasional lifting of paperwork, eligibility packages, Summary Plan Description boxes.

Must be able to move to different workstations as position needs warrant.

Work Environment - Fast-paced department. Phone calls are continuous and occasionally unpleasant. Must be able to maintain composure with difficult callers. Most work is done independently. Must be able to multi-task. Must be detail oriented.

May have to manage several projects at one time and may be interrupted frequently to meet the needs and requests of multiple clients. The environment is busy, noisy and requires excellent organizational, time, and stress-management skills to complete the required tasks.

Work Schedule - Full time. Monday - Friday, 8:00am - 4:30pm. Required in office (No at-home days).

Competitive Benefits and Compensation Package

• 12 paid holidays
• Paid Time Off (PTO)
  • Pro-rated during first year of employment
  • 15 days of PTO provided in the next calendar year!
• 3 days paid bereavement
• Up to 20 days paid jury…