Member Service Representative, MercyCare

Mercy-Health-System-Corporation; Janesville (WI); On-site; USD 26,000 - 41,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid time off

Tuition reimbursement

Job summary

Mercyhealth is hiring for a member services specialist to assist patients with benefits, coverage, and pharmacy needs in a fast-paced call center environment.

You will handle escalated calls, document information, and guide members through Mercyhealth online resources while scheduling appointments and processing authorizations.

Qualifications

• High school education preferred.
• Experience in health insurance or call center is a plus.
• Strong communication and problem-solving abilities.

Responsibilities

• Handle escalated calls and resolve complex member issues.
• Answer incoming calls and assess member needs.
• Document required information in computer systems.

Skills

Customer service

Communication

Problem solving

Education

High school diploma or equivalent

Tools

Pharmacy PBM system

Job description

OVERVIEWSupport health insurance members by answering questions, resolving complex issues, and helping patients understand their benefits, coverage, pharmacy needs, and authorization requests. This role serves as a knowledgeable resource for members and team partners while delivering excellent customer service, problem-solving support, and timely follow-up in a fast-paced call center environment.SCHEDULE: 40-hours per weekSHIFT: DaysESSENTIAL DUTIES AND RESPONSIBILITIESServe as a resource or Subject Matter Expert (SME) for other team members or internal members in the following areas: WI and Illinois Group EPO, HMO, PPO, POS lines of business WI and Illinois Individual Marketplace WI Medicaid WI Medicare Supplemental Insurance WI and Illinois Pharmacy RidersHandle escalated calls, resolving more complex member issues in a one-and-done mannerAnswer incoming phone calls from members and identify the type of assistance the member needsAsk appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systemsAssist members in navigating Mercyhealth’s websites and encourage and reassure them to become self-sufficientAssist members in choosing a primary care physician and scheduling their first appointment or when assistance getting an appointment is asked for by the memberOwn problem through to resolution on behalf of the member in real-time or through comprehensive and timely follow-up with the memberResearch complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issuesProvide education and status on previously submitted pre-authorizations or pre-determination requestsResponsible for entering all approved authorizations into the pharmacy benefit management system. Also responsible for entering overrides to ensure members receive their prescriptions promptly.Assist in taking premium payments from members for our marketplace line of business.Meet the performance goals established for the position in the areas of first-call resolution, service level, occupancy rate, percentage of calls held, redirect, attendance, NCQA required audits, and any contractual requirements (ETF, Medicaid, etc.)EDUCATION AND/OR EXPERIENCEHigh school education preferredPAY RANGE:$18.65 - $29.84Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.Mercyhealth offers competitive pay and a comprehensive benefits package including:Medical, Dental, VisionLife & Disability InsuranceFSA/HSA OptionsGenerous, accruing paid time offPaid Parental and caregiver leaveCareer advancement and educational opportunitiesTuition and certification reimbursementCertification ReimbursementWell-being ProgramsEmployee DiscountsOn-Demand PayFinancial EducationAnnual recognition/awards eventsPartner appreciation daysFamily entertainment/attractions discountCommunity service/improvement opportunitiesClick here for more details regarding Mercyhealth Careers Benefit Information.At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.Mercyhealth has been nationally recognized for our commitment to our people and culture, including:#1 in the nation on AARP's Best Employers for Workers Over 50One of Working Mother magazine's 100 Best Companies for Working MothersA Top 50 Company and Top 10 Nonprofit for Executive Women