Healthcare Service Representative (Troy, MI)

Essential Duties And Responsibilities

• Answer participant calls, mail requests and resolve issues.
• Know and apply plan rules for eligibility as outlined in the Summary Plan Description (SPD).
• Aid members and dependents with all benefit-related issues.
• Explain eligibility rules to members and provide enrollment documents.
• Handle death notifications and communicate with vendors.
• Comment system when changes are made to participant records or when participants call.
• Assist with deductibles, out-of-pocket accumulators, dental, vision, and medical benefits, MRA, or Bennycard inquiries.
• Status medical, dental, and vision claims for members and some providers.
• Maintain records of all interactions with members/providers.
• Make outgoing calls to members, providers, collection agencies, and vendors to resolve claims or eligibility issues.
• Follow up with members to ensure issues are resolved.
• Request check tracers and submit escalations to management for complex calls.
• Enter change of address notifications and submit annual opportunities for increases.

Qualifications

• Excellent customer service skills.
• Proficient in using Word, Outlook, and Excel.
• Preferred qualification: Spanish speaking.

Education and/or Experience

• Post-high school education or prior related work experience preferred.

Work Environment

• Fast-paced department.
• Continuous phone calls, occasionally unpleasant.
• Maintain composure with difficult callers.
• Must be able to sit for up to eight hours each day and stand for one-to-three-hour intervals.
• Occasional lifting of paperwork, eligibility packages, and Summary Plan Description boxes.
• Must be able to move to different workstations as needed.
• Requires excellent organizational, time, and stress-management skills.
• Busy, noisy environment.
• May have to manage several projects at once and be interrupted frequently.
• Full-time schedule: Monday – Friday, 7:30am - 4:30pm.
• Required to be in the office (no at-home days).

Pay

The hourly rate is $23.00. Actual rate dependent on location, skills, education, experience, and other business factors.