Member Benefits Specialist - Member Services Professional

Position Location: 100% remote

Responsibilities

• Deliver above and beyond service over multiple channels including phone, email, portal inquiries, etc. by acting as a single point of contact, maintaining ownership of member resolution
• Become an expert in benefit administration, Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Level Funded plans, minimal essential coverage plans and alternative benefit payment designs (specifically reference based pricing)
• Guide understanding of health benefit coverage including accumulators, explanation of benefits, out of pocket maximums, reimbursement levels, and federal regulations such as NSA and ACA
• Take ownership of the member experience from beginning to end, reducing handoffs to others to ensure consistency and resolution
• Anticipate the needs of members and conduct research on members' behalf to resolve issues
• Educate members on pre and post services in conjunction with benefit to optimize the member experience throughout their healthcare journey
• Collaborate with internal and external partners to ensure a best-in-class service delivery
• Resolve member complaints
• Treat all calls and correspondence using procedures and paying attention to the sections relating to HIPAA guidelines and the HIPAA Privacy Rules
• Complete provider research, appointment scheduling, medical record retrieval and all other non-clinical duties assigned within applicable timeframes in compliance with Policy & Procedures
• Accurate documentation in appropriate software

Requirements

• High school diploma or GED
• 1+ year healthcare industry work experience
• Experience in delivering client-focused solutions based on customer needs within direct member contact and education (ideally virtual/telephonic, in-person experience with the public)
• 1+ year with telephonic verification of medical benefits preferred
• 2+ years healthcare experience (e.g., carrier, TPA, patient advocate, or other benefits focused role) preferred
• Medical claims exposure (ICD-9/10 coding, CPT coding, and medical claim forms) preferred

Skills

• Proficient in Microsoft Outlook, Word and Excel
• Service-driven mindset
• Aptitude for learning and retention
• Advanced soft skills with a high level of emotional intelligence
• Strong written communication skills

Benefits

• Multiple health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives