Customer Engagement Representative, Member Serv I

PURPOSE: The Rep Member Service I is proficient in routine benefits claims and general inquiries. They have a general knowledge of the following: systems benefits contracts/products functions of other departments in the company standard operating procedures claims status enrollment/billing and follow-up to a customer inquiry.

ESSENTIAL FUNCTIONS:
Answers member inquiries by clarifying desired information; researching locating and providing information. Resolves member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.

Examines claims to identify key elements and processing requirements based on diagnosis procedures provider medical policy contracts and policy and procedures. Calculates deductibles maximums and determining resolving reporting and following through on overpayments underpayments and managed care processes.

Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines generating accurate billing for policies and products purchased by new clients existing clients and transfers from other Client Plans. Learns the details of offering and administering various billing transactions i.e. direct pay credit card payment and debit accounting through the policyholders checking account and how to effectively interact with or advise clients group administrators brokers or providers on problem resolution.

Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.

Qualifications
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma or GED

Experience: 1 year customer service claims experience Inbound Call Center Experience

Preferred Qualifications
Experience performing duties that are detailed in nature exposure to health care health insurance medical information and direct service experience is preferred.

Knowledge Skills and Abilities (KSAs)
Self-starter with strong organizational skills and planning skills. Proficient
Ability to maintain effective interpersonal relationships Proficient
Ability to recognize analyze and solve a variety of problems. Proficient
Excellent communication skills both written and verbal. Proficient
Maintains quality customer services by following customer service practices; responding to customer inquiries. Proficient

2-5 Years inbound call center experience
The incumbent uses knowledge of products and the contractual provisions that govern administration to provide client education to interpret contract data and business rules to clients for the purpose of supporting client business and member support objectives through telephone communication or written correspondence. Documents all client interactions according to established procedures.
Examines member records to identify key elements and processing requirements based on established business rules policies and procedures. Researches investigates and resolves problems related to member data or records and communicates resolution clearly and effectively
To effectively interact with clients the incumbent must develop and apply an expert ability to analyze client needs. Responds to telephone and written inquiries from internal and external customers regarding contract data.
Provide support for the execution of enrollment transactions in accordance with contractual and medical underwriting guidelines for new clients existing clients and transfers to and from other Client and Non Client Plans. Learns the details of offering and administering various enrollment transactions and how to guide various customers regarding problem resolution.
Learns to access information from FEPOC automated systems and by telephone and written inquiry with various clients. Responds to client inquiries.
To effectively administer service the incumbent must utilize a range of automated systems including but not limited to FEPDirect NICE OnBase Advance Capture etc.
Possess a passion for Customer Service
Innovative thinking and drive for results
Display exceptional oral and written communication skills.
Possess independent self-starter skills required to be a dependable and productive remote agent
Capability to navigate concurrently between multiple software systems with relative ease.
Ability to interface with a culturally diverse population
Working knowledge of basic computer functions including Microsoft products internet research and email communication.
Work experience in a Quality/Production driven environment
Position requires performance in either service or claims for a minimum of 18 months at a meets standard level or above.
Must have previous customer service and/or claims experience.
Additional required experience includes use of automated systems PC or CRT proficiency excellent oral and written communication skills time and organizational management and successful project management.
Experience performing duties that are detailed in nature exposure to health care health insurance medical information and direct service experience is preferred.

Software & Tools:
MS Office Suite Visio Adobe Acrobat FEPDirect OnBase Advance Capture NICE



**Talteam Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin or protected veteran status and will not be discriminated against on the basis of disability.**