Member Service Representative I

Cascade Comprehensive Care; Klamath Falls (OR); On-site; USD 34,000 - 46,000; Full time

Job summary

Cascade Comprehensive Care in Klamath Falls, Oregon seeks a member services specialist to help members and providers with inquiries, benefits information, and necessary authorizations. You will document contacts, ensure data accuracy, and maintain HIPAA compliance while delivering patient-centered service.

Requirements include a high school diploma or GED and 2–4 years of related experience. Strong communication and organizational skills are essential, with bilingual Spanish preferred to enhance

Qualifications

• High school diploma or GED; 2–4 years related experience or training.
• Ability to communicate by email and document data accurately.
• Bilingual Spanish preferred.

Responsibilities

• Provide clear and concise benefit information to members.
• Assist members and provider partners with authorizations, assignments, eligibility, and claim status; research inquiries as needed.
• Document calls in required data systems clearly and accurately.
• Analyze member and provider inquiries to determine steps for resolution.
• Maintain confidentiality and comply with HIPAA rules and regulations.
• Balance multiple tasks with strong organizational skills and prioritize steps to complete tasks timely.

Skills

Customer service

Communication skills

Bilingual Spanish

Data entry

HIPAA compliance

Education

High school diploma / GED

Job description

Job Description

This position is responsible for interacting with members and providers, analyzing inquiries and providing clear and accurate information in a timely manner. This position is also responsible for documenting member contact in appropriate data systems by performing the following duties.

• Provides benefit information in a clear and concise manner.
• Assists members and provider partners with authorizations, assignments, eligibility, claim status and researches inquiries that require additional information not readily available in the internal and external member data systems.
• Documents calls in required data systems in a clear and concise manner.
• Analyzes member and provider inquiries and determines steps for resolution.
• Ensures accuracy of member information and assists members with redetermination processes for continuation of coverage.
• Assists members with benefit coverage questions.
• Conducts appropriate research, follow-up and status updates to members as calls are processed and resolved.
• Relays information to appropriate departments and personnel using established communication procedures.
• Initiates welcome touch point calls to new members.
• Seeks to develop and improve communication skills, conflict resolution, and team effectiveness.
• Enters data in various programs requiring proficient and accurate typing skills.
• Balances multiple tasks utilizing excellent organizational skills and prioritizes necessary steps to accomplish tasks timely and accurately.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
• Respectfully takes direction from manager.

Bi-lingual in Spanish is preferred.

EDUCATION And/or EXPERIENCE

High school diploma or general education degree (GED); and two to four years related experience and/or training; or equivalent combination of education and experience.

Computer Skills

Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.

We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. We are an Equal Opportunity Employer.

Background Check & Drug Screen Required