Member/Participant Service Representatives

SUMMARY

Seeking a well-rounded person able to communicate health care benefits clearly to Participants, Providers and Trustees. Candidates must also possess a desire bring the issue of the Participant/Providers to a resolution.

Excellent opportunity to get in on the ground floor of a company that includes employees as part of the team and delivers excellent wages and benefits.

GENERAL DUTIES AND RESPONSIBILITIES including but not limited to:

• Respond to Member and Provider calls in a courteous and professional manner, answering questions and inquiries regarding membership eligibility, benefits, claims, policies and procedures.
• The candidate will also educate members and providers on the guidelines of their healthcare benefits.
• Assesses and resolve problems within the scope of authority; escalates complex questions or problems to more experienced representatives or higher authority level.
• Works with Claims, Provider Relations and Health Services staff and the ability to work independently and most importantly works very well in a Team oriented environment
• Documents all incoming / outgoing calls.

REQUIREMENTS:

• Must have excellent communication skills and be capable of taking a high volume of customer calls.
• Proficient with computers including keyboarding including 10-key (demonstrated ability to type quickly and accurately) and use of Microsoft Word, Outlook, and Excel.
• Must have excellent decision-making, problem-solving, organizational skills and able to work in a “team” environment.
• 2-4 years of customer service experience
• 2-4 years’ experience in employee benefit plan administration including understanding of health plan claims
• Working knowledge of employee benefit plans and regulations and the ability to explain benefits and claims protocols to others.
• Taft-Hartley experience is a plus
• Ability to read, write and speak Spanish is preferred, but not required
• Medical terminology classes, knowledge of medical billing and codes ICD9 and CPT coding is a plus.