Customer Engagement - Representative, Member Serv I

Mindlance; Washington (District of Columbia); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading customer service provider is seeking a Customer Engagement - Representative, Member Service I. The representative will manage member inquiries, process claims, and assist with enrollment transactions. Ideal candidates will have a High School diploma and 1 year of customer service experience, preferably in health care. Strong communication and problem-solving skills are essential. Join a dynamic team in Washington, DC.

Qualifications

• 1 year of customer service experience, preferably in a call center.
• Experience with claims processes is preferred.
• Ability to maintain effective interpersonal relationships.

Responsibilities

• Answer member inquiries by researching and providing information.
• Examine claims for processing requirements.
• Learn to execute enrollment transactions accurately.
• Collaborate with clinical professionals for managed care interventions.

Skills

Organizational skills

Interpersonal skills

Problem-solving

Written and verbal communication

Customer service

Education

High School Diploma or GED

Job description

Overview

Customer Engagement - Representative, Member Service I

The Rep, Member Service I is proficient in routine benefits, claims, and general inquiries. They have a general knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry.

Responsibilities

• Answers member inquiries by clarifying desired information; researching, locating, and providing information. Resolves member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
• Examines claims to identify key elements, and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures. Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments, and managed care processes.
• Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other Client Plans. Learns the details of offering and administering various billing transactions, i.e. direct pay, credit card payment, and debit accounting through the policyholders checking account, and how to effectively interact with or advise clients, group administrators, brokers, or providers on problem resolution.
• Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma or GED

Experience: 1 year customer service, claims experience, Inbound Call Center Experience

Preferred Qualifications: Experience performing duties that are detailed in nature, exposure to health care, health insurance, medical information, and direct service experience is preferred.

Knowledge, Skills and Abilities (KSAs): Self-starter with strong organizational skills and planning skills. Proficient; Ability to maintain effective interpersonal relationships. Proficient; Ability to recognize, analyze, and solve a variety of problems. Proficient; Excellent communication skills both written and verbal. Proficient; Maintains quality customer services by following customer service practices; responding to customer inquiries. Proficient.

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

EEO: Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.