Member Services Representative

About the role

The Member Services Representative (“MSR”) is responsible for receiving, answering, and/or resolving calls received through a remote Call Center. The Call Center receives phone calls from insureds and their dependents, providers and their staff, employer/group staff, and brokers. The MSR will use the company's Claims/Eligibility database to inquire on the status of claims, ID cards, addresses, and other issues as queried by the caller. Additionally, the MSR is the primary source for issuing authorizations when eligible for services.

Responsibilities

• Provide timely and accurate information to basic incoming customer calls from members, providers, and other external & internal constituents including:
• Issuing authorizations
• Handling claims inquiries from providers and members
• Communicate the correct information regarding accessibility, claims status and other calls of a service nature
• Process customer claims according to established department policies and procedures
• Check voicemail boxes and handle customer/provider requests for:
• I.D. cards
• Authorizations
• Customer Service questions and issues
• Fulfill rapid call volume by handling the appropriate number of calls coming into the call center daily
• Complete Provider Relations requests for service
• Partner with Sales and Provider Relations to meet and exceed customers’ expectations
• Handle all customers in a professional and courteous manner
• Perform other duties as assigned

Requirements

• Education: High School Diploma or Equivalent Required
• Experience: 2 Years Required
• Notes: 2+ years of customer service or call center experience preferred, 2+ years of experience in the health care industry or insurance environment preferred, Associates degree in lieu of experience will be considered

Skills

• Compliance with HIPAA & Security Requirements

Benefits

• Medical, dental, and paid vision coverage
• Paid time off and company holidays
• Retail savings with employer contribution
• Employee wellness resources
• Professional development opportunities

Pay

This role is compensated on an hourly basis. The expected hourly pay range for this position is $19.00 – $21.00 per hour, based on factors such as experience, skills, and role requirements.

Schedule

Actual pay within the range will be determined during the hiring process and in accordance with applicable wage and hour laws.