Member Services Representative

Manitoba Blue Cross; St. James Industrial; Hybrid; CAD 42,000 - 62,000; Full time

Benefits offered by this job

Hybrid work

Health benefits

Casual dress code

Onsite fitness center

Development opportunities

Competitive salary

Job summary

Manitoba Blue Cross is seeking a customer-focused professional to handle diverse inquiries from members in person and by phone. You will adjudicate claims, assist with enrollment and billing, and explain benefits with accuracy and empathy.

Ideal candidates have strong data-entry skills, excellent communication, and the ability to work in a fast-paced health benefits environment, with a commitment to service excellence.

Qualifications

• Post-secondary education in Business Administration or a related field, or equivalent experience.
• Proven ability to provide high-quality customer service with accuracy in data entry.
• Strong communication and interpersonal skills with attention to detail.

Responsibilities

• Respond to diverse customer inquiries in person or by telephone with first-call resolution when possible.
• Adjudicate and process health and dental claims and pre-authorizations within standard guidelines.
• Assist with enrollment, billing procedures, and plan-specific inquiries, including coverage information.

Skills

Customer service

Communication

Data entry

Problem solving

Time management

Team work

Education

Business Admin education

Tools

MS Word

MS Excel

Email apps

Job description

About Manitoba Blue Cross

We’re a Manitoba-based, not-for-profit, health benefits provider with a vision to be the trusted and essential health and wellness partner for all Manitobans. Every dollar made is reinvested in our infrastructure, our people, and our province with the goal of providing better care for our members, expanding our community impact and broadening our health care knowledge.

Why work for us?

Manitoba Blue Cross, is a Manitoba Top Employer. We are empowered to give back to the community, and we know that caring needs to start in our workplace with our own Manitoba Blue Cross team. We actively foster a culture that focuses on your satisfaction, development, diversity, and growth.

Culture of Caring

We strive to succeed at reaching our organizational goals, but we always make time to celebrate our successes. Having fun as a group and rewarding our employees for their accomplishments is an essential part of our workplace culture.

We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace. We offer a work environment that promotes a healthy work-life balance and support to advance your career that includes:

• Competitive starting salary.
• A comprehensive health benefit package.
• Hybrid work environment, flexible work schedules.
• Fully equipped onsite fitness center.
• Casual dress code to promote diversity and inclusivity.
• Personal and professional development.

Are you a driven, dedicated, and enthusiastic individual who wants to work in a friendly and rewarding environment? If so, we are looking for someone like you! The following position is open to anyone residing in Winnipeg and surrounding areas with valid work authorization.

POSITION SUMMARY

The position encompasses both responding to diverse and complex inquiries from customers in person and by telephone, as well as assessing, adjudicating, and processing claims.The incumbent requires extensive knowledge of all of the company’s products and administrative practices relating to company procedures.

DUTIES AND RESPONSIBILITIES

• Respond to a variety of customer inquiries adhering to the principal of first call resolution wherever possible. Inquires can include:
  • Enrollment and billing procedures.
  • Claims procedures and claims payments.
  • Coverage information.
  • Plan specific inquiries related to Ambulance/Hospital, Extended Health, Travel, Dental, Health Spending Account, Wellness Spending Account and Vision Care.
• Confirm coverage, explain benefits and ensure claim requirements are explained and understood by both members and providers.
• Check for processed claims for dental offices, hospitals, pharmacies, and various other health providers and members, including resolution of any issues and performing any corrective action.
• Accurately complete an inquiry ticket for each call received and complete forms and memos as needed.
• Accurately adjudicate and process standard and diverse Ambulance/Hospital, Extended Health, Dental, Health Spending Account, Wellness Spending Account and Vision Care claims and pre-authorizations in accordance with performance standards.
• Assist in the management of pended claims in the Claims Workplace as assigned.
• Ensure claims/queries for clients with Service Level agreements are adjudicated within the standards set out in the agreement.
• Manage and update Coordination of Benefits (COB) information, ensuring the correct adjudication of claims.
• Return claims for completeness of information and communicate with members and providers to obtain any necessary additional information whenever possible.
• Remain current and knowledgeable about benefits which are provided by the Provincial Health Care Plan, particularly in respect to prescription drugs, travel health and vision care.
• Process Bonds of Indemnity for lost or stolen cheques, distribute explanation(s) of benefits, process or forward requests for address changes and identification cards for members to the appropriate department.
• Promote and sell Travel products.
• Assist members with registration and navigation of the online portal.
• Accept and forward customer suggestions and complaints about all aspects of Blue Cross, including billing and enrollment, claims, products and/or benefits.
• Forward possible leads for group health business to the Sales department.
• Forward possible leads for individual health business to the Individual Products team.
• Prepare for and deal effectively with customers who contact our office following radio programs, newspaper articles, mass mailings, etc.
• Assist the Customer Service Centre with in-person inquiries as required.
• Assist with replying to customer emails if required.
• Assist in directing customers to the appropriate source (i.e.: Government Agency) when the information does not pertain to Blue Cross.
• Assist Travel Agents and General Agents in selling, extending and refunding Travel Health, Trip/Holiday Cancellation and the Tour Package Plan as well as explaining coverage information and claims procedures.
• Maintain an awareness of changes to employer group plans in order to respond to customer inquiries.
• Accurately adjudicate and process standard health and dental claims.
• Manage and update Coordination of Benefits (COB) information, ensuring the correct adjudication of claims.
• Return claims for completeness of information and communicate with members and providers to obtain any necessary additional information whenever possible.
• Remain current and knowledgeable about benefits which are provided by the Provincial Health Care Plan, particularly in respect to prescription drugs, travel health and vision care.
• Mail and administrative duties (sorting, scanning, indexing, document management).
• Perform other duties as assigned.

SKILLS & QUALIFICATIONS

• Dedicated to the principles of exceptional service; committed to responding to, anticipating, and addressing customer needs, for both internal and external customers
• Post-secondary education in Business Administration or a related field (University degree or Community College diploma), or an equivalent combination of education and relevant experience.
• Proven ability to provide high-quality customer service while maintaining accuracy in data entry and documentation.
• Excellent written, verbal, and interpersonal communication skills, with strong active listening and relationship-building capabilities.
• Strong attention to detail, with the ability to maintain accuracy and confidentiality in a service-driven environment.
• Well-developed organizational and time-management skills, with the ability to manage multiple priorities and meet deadlines in a fast-paced setting.
• Ability to remain composed and professional under pressure, demonstrating flexibility, patience, and sound judgment.
• Strong problem-solving, analytical, and numerical skills, with the ability to assess situations and identify appropriate solutions.
• Ability to work effectively both independently and collaboratively within a team environment, with the flexibility to adapt to changing priorities.
• Strong computer proficiency, including Microsoft Word, Excel, and email applications, with the ability to learn new systems quickly.
• Several years of experience providing direct service to members, clients, or the general public in a professional setting.
• Experience in member services, insurance, healthcare, or a related customer-focused industry is considered an asset.
• Knowledge of health benefits, pharmacy, medical products, dental services, and related terminology, or completion of a medical certificate program, is considered an asset.
• Proficiency in a second language is considered an asset.

We appreciate the interest expressed by all applicants and acknowledge the effort put into the application process, however only those selected for an interview will be contacted.

Manitoba Blue Cross is committed to the principles of diversity, equity & inclusion and to promoting opportunities in hiring for everyone. We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace.

We encourage all qualified candidates to apply. If you require an accommodation during the hiring process, please let us know.