Member Services Rep

Job Summary:

The Member Service Representative is the face of Select Health Plan and directly impacts the members service experience by how well customer service inquiries and problems via telephone Internet or written correspondences are handled. The MSR always maintains a positive caller experience.

Job Responsibilities:
-Documents and tracks contact with members providers and plan sponsors; ensuring calls and rework are distributed to the appropriate staff.
-Guides the member through their member plan of benefits MCSHP policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
-Creates an emotional connection with our members by understanding and engaging the member to the fullest to advocate for our members best health.
-Takes accountability to fully understand the members needs by building a trusting and caring relationship with the member.
-Anticipates members needs. Provides the customer with related information to answer the unasked questions (e.g. additional plan details benefit plan details member self-service tools etc.)
-Explains members right and responsibilities in accordance with the contract and regulatory requirements.
-Support all Member and Provider Services phone queues as required. (Medical Management Claims Provider Services)
-Process member grievances and appeals received by telephone fax email and through Selects member portal.
-Meet or exceed productivity and quality standards as assigned by management.
-Take responsibility for various projects as assigned by management and perform any
additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
-Work as a team player and communicate in a positive manner with co-workers managers providers and other contacts.
-Maintain patient confidentiality at all times.
-Educates provider on MCSHPs self-service options.
-Responds to subpoena requests for medical and claims records.
-Handles incoming requests for appeals and pre-authorizations not handled by Medical Management.
-Performs review of member claim history to ensure accurate tracking of benefit maximum and/or coinsurance/deductible.
-Use applicable systems tools and resources to produce quality responses to inquiries received.
-Manage and direct all incoming/out-going phone calls to appropriate resources in a professional manner.
-Maintain a high level of organization and attention to detail.
-Managing incoming and outgoing mail for all departments including timely pick-up and drop off to mailroom.
-Monitoring of all inventory for member mailings (Denials Approvals etc.)
-Achievement of productivity and quality standards as established by management.
-Review own work for accuracy reasonableness and completeness before or when due.
-Demonstrate a willingness to learn new procedures readily accept new responsibilities participate and contribute to the overall success of the department.
-Take responsibility for various projects as assigned by management; and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
-Provide assistance as needed and perform other tasks assigned as needed by the organization.
-Interface effectively with other departments and all levels within the organization.
-Excellent communication skills including the ability to write and articulate in a clear concise and persuasive manner to effectively present ideas with ease.
-Demonstrate ability to be empathetic and compassionate.

Required Skills & Experience:
-Minimum of two (2) years of experience in a transaction-based environment such as a call center or similar environment.
-Basic computer skills including general knowledge of MS Word and Excel applications type minimum of 45 WPM.

Preferred Skills & Experience:
-Experience in a managed healthcare environment.
-Bi-lingual (Spanish/English).

Required Education:
-High school graduate or equivalent.

Preferred Education:
-Bachelors degree.

Required Certifications & Licensure:
-Specialty coding certification.