Healthcare Member Services Specialist

Alliance Coal LLC; Tulsa (OK); On-site; USD 32,000 - 52,000; Full time

Job summary

Alliance Coal LLC is seeking a diligent Member Services Representative to serve as the frontline contact for health plan participants, HR staff, and providers with regard to eligibility, benefits, claims questions, and documentation processing. The role involves handling mail, email, faxes, and electronic records while ensuring proper filing and secure handling of information.

The candidate will support Care Coordination, Care Navigation and Claims Teams, maintaining confidentiality and

Qualifications

• 1+ year of healthcare or medical insurance customer service experience.

Responsibilities

• Receive, respond to and/or refer inbound employee, provider and physician documentation.
• Log, scan and route vital claim documents and attach DCN numbers.
• Maintain medical record archives and upload records to the electronic system.
• Collaborate with Care Coordination, Claims Teams and other HealthPlan groups.
• Identify and escalate repetitive questions to expedite resolution.
• Perform projects and duties as needed.

Skills

Customer service

Listening skills

Medical claims processing

HIPAA knowledge

CPT/HCPCS/ICD-9/10

Documentation & record keeping

Microsoft Office

Education

High school diploma or equivalent preferred

Tools

Microsoft Office

Cloud storage systems

Job description

Alliance Coal LLC is seeking a diligent Member Services Representative to serve as the frontline contact for health plan participants, HR staff, and providers with regard to eligibility, benefits, claims questions, and documentation processing. The role involves handling mail, email, faxes, and electronic records while ensuring proper filing and secure handling of information.

The candidate will support Care Coordination, Care Navigation and Claims Teams, maintaining confidentiality and