Customer Service Representative, Medicare Advantage

McLaren Health Care; Flint (MI); On-site; USD 32,000 - 42,000; Full time

Job summary

McLaren Health Plan is seeking a Customer Service Representative to handle daily member telephone calls, directing members to the proper services and educating them on benefits. The role involves problem solving and creating linkages to the Medical Management Department for service authorization.

You may also assist providers with eligibility, benefits, and resolution of claims issues. Full-time position with structured schedule, requiring clear communication, empathy, and reliable teamwork in a

Qualifications

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

Responsibilities

• Handle daily member telephone calls, directing members to the proper services and educating them on benefits.
• Problem solving and creating linkages to the Medical Management Department for authorization of services.
• Assist providers with eligibility, benefit, and resolution of claims issues.

Skills

Customer service

Communication

Problem solving

Education

High School Diploma

Job description

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.

Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

Position Summary

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
• Requisition ID: 26004656
• Daily Work Times: 10:30 AM - 7:00 PM
• Hours Per Pay Period: 80
• On Call: No
• Weekends: Yes