Customer Service Representative, Medicare Advantage

Mclaren-Health-Care; Flint (MI); On-site; USD 22,000 - 30,000; Full time

Job summary

McLaren Health Plan is seeking a Customer Service Representative to handle daily member calls, educate members on benefits, and coordinate with Medical Management for authorizations. The role requires interaction with providers on eligibility, benefits, and claims issues.

Ideal candidates will have strong customer service experience, capable communication skills, and a commitment to high-quality service for Michigan residents enrolled in Medicare Advantage.

Qualifications

• High School Diploma or equivalent certification.
• One year of customer service experience with direct contact via phone, email, chat or face-to-face.

Responsibilities

• Handle daily member telephone calls and direct them to the proper services.
• Educate members, problem solve and create linkages to Medical Management for authorization of services.
• Assist providers with eligibility, benefit, and resolution of claims issues.

Skills

Customer service

Telephone support

Communication

Education

High School Diploma or equivalent

Job description

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.

Customer Service Representative, Medicare Advantage

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Customer Service Representative, to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member.MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life.McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP,you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.

Qualifications:
Required:

• High School Diploma or equivalent certification.
• One (1) year experience in a customer service related role with direct contact with customers via telephone, email, chat and/or face-to-face.

Preferred:

• One (1) year experience in a physician health care office environment or high-volume call center.
• One (1) year experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions.

Additional Information

• Schedule: Full-time
• Daily Work Times: 10:30 AM - 7:00 PM
• On Call: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

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McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.