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. This is a long term contract position! 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.
- Answer, resolve, track and document telephone calls from members, providers internal departments, and external agencies, in a timely and professional manner
- Interpret member eligibility and coverage thorough knowledge of the contracts, policies and procedures.
- Communicate with internal departments, members, providers and other customers regarding the transportation benefit in both verbal and written form, including faxing rides to providers at the appropriate times
- 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
Enrollment, eligibility, ID cards, clinic changes, demographic changes, benefit coverage, claims, payments, member reimbursement, and demonstrated knowledge of CAG policies, procedures, and regulations
- 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.
- High school Graduate or the equivalent required
- 2 Year degree in a health related, liberal arts or communication field including a course with medical terminology preferred
- 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 knowledge of Microsoft office preferred
- 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