Humera - Administrative and Professional Staffing

Member Service Representative

Location
Minneapolis, MN, United States
Salary
Contact For Rate
Posted
May 14, 2017
Closes
May 23, 2017
Job Type
Employee
Employment Status
Full Time
Member Service Representative:
Humera has several positions available for Member Service Representatives with our client in NE Minneapolis, an independent, nonprofit health plan that provides health coverage and services. The candidates in these positions will provide accurate timely responses, resolution to inquiries, and informal grievances from members, authorized parties, county/state representatives and other internal/external customers. The customer contact takes place via phone, written correspondence, web, fax, voice mail or face-to-face contact. These are long term contract opportunities.
This position is responsible to apply knowledge of the client's business, products, members and operations to accurately and effectively fulfill member service requests and inquiries. Ensure adherence to policies and procedures and meet service level expectations by following established guidelines and standards. Achieve fluency in at least one core product or service line.

Duties:

  • Answer, resolve, track and document telephone calls from members, providers internal departments, and external agencies, in a timely and professional manner, Research, resolve and communicate effectively with internal and external customers regarding member/provider concerns or issues. Educate members and external customers on policies and procedures related to members health care program.
  • Research and resolve inquiries from internal/external customers including: Enrollment, eligibility, ID cards, clinic changes, demographic changes, benefit coverage, claims, payments, member reimbursement, and demonstrated knowledge of CAG policies, procedures, and regulations and will utilize appropriate resources to respond to member inquiries.
  • Identify trends/issues that emerge in calls/correspondence, and inform team Lead or Supervisor; assist in the development and communication of resolutions to internal staff, as requested.
  • Demonstrate and maintain a thorough and complete working knowledge of appropriate information management systems, and ACD telephone system.
  • Maintain good working relationships and open communication with internal and external customers.
  • Attend department and other meetings as requested.
  • Other projects and duties as assigned.

Requirements
  • One to two years call center experience or two years customer service experience.
  • Preference given to candidates with health insurance (HMO), physician group practice, or community agency.
  • Proficient PC skills required
Preferred Experience
  • Working knowledge of medical claims and/or medical billing processes is preferred.
  • Proficient computer skills; knowledge of Microsoft office, Amisys, and MACESS type software packages.