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Solxsys Administrative Solutions, LLC
Member/Participant Service RepresentativesSolxsys Administrative Solutions, LLC • Walnut Creek, CA, US
Member/Participant Service Representatives

Member/Participant Service Representatives

Solxsys Administrative Solutions, LLC • Walnut Creek, CA, US
30+ days ago
Job type
  • Full-time
Job description

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.

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Member/Participant Service Representatives • Walnut Creek, CA, US

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