Member Services Representative (EST or CST Time Zone Only)

ArchWell Health; Charlotte (NC); On-site; USD 32,000 - 52,000; Full time

Job summary

ArchWell Health is seeking a Member Services Representative to help members navigate the complex healthcare system, verify primary care physician assignments and eligibility, and coordinate with insurance plans to ensure accurate ArchWell enrollment.

The ideal candidate will have experience in healthcare, strong attention to detail, and the ability to work with diverse populations. Proficiency in Microsoft Office, including Excel, and familiarity with EMR systems are preferred.

Qualifications

• High school diploma or GED required.
• Minimum one year in healthcare, preferably benefits/insurance.
• Experience with EMR systems preferred (eClinical Works).

Responsibilities

• Outreach to members and insurance partners by phone.
• Document all member and payer outreach.
• Assist members with problems navigating the health care system.
• Validate provider data with insurance partners.
• Use spreadsheets to track membership and interactions.

Skills

MS Office

Excel

Interpersonal skills

Medicare Advantage knowledge

Healthcare communications

Education

High School Diploma or GED

Experience in healthcare

Tools

eClinical Works

Job description

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.

Job Summary:

The Member Services Representative is responsible for providing outreach to our members to help them navigate the complex healthcare delivery system. This will entail verifying their primary care physician and eligibility and contacting their insurance plan when applicable to ensure they are assigned to ArchWell Health. This role has the potential to handle provider data management and will need to verify AWH provider information with these insurance partners when applicable. An ideal candidate will have a deep understanding of the healthcare ecosystem, have strong attention to detail, and be driven by a passion for providing quality care to seniors.

Duties/Responsibilities:

• Outreach to members and insurance partners over the phone to verify members are assigned to ArchWell Health and schedule members for appointments
• Complete proper documentation of all member and payor outreach
• Assist members in problem solving potential issues related to the health care system
• Validate provider data on file with insurance partners
• Utilize and manipulate shared Excel spreadsheets to track membership and interactions.

Required Skills/Abilities:

• Proficient PC skills to include Microsoft Office and Excel
• Passion for helping senior members successfully carry out care plans
• Ability to work effectively with diverse populations including staff, providers, members, family members, insurance carriers, vendors, and the public
• Basic medical terminology
• Understanding of Medicare Advantage

Education and Experience:

• High school diploma or equivalent education (GED) required
• A minimum of one year working in healthcare, ideally with experience related to benefits and insurance required
• eClinical Works or similar EMR experience preferred

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.