Member Services Representative (EST or CST Time Zone Only)

ArchWell Health; Jacksonville (FL); On-site; USD 45,461,000 - 57,859,000; Full time

Job summary

ArchWell Health in Jacksonville, FL is seeking a Member Services Representative to help our seniors navigate the complex healthcare system. You will verify members' primary care physicians and eligibility, and coordinate with insurance plans to ensure proper ArchWell assignment.

The role may involve provider data validation with partners and advancing our mission of respectful, accessible care. The ideal candidate will have strong attention to detail, proficiency with Microsoft Office and Excel,

Qualifications

• High school diploma or GED required.
• At least 1 year of healthcare experience, preferably related to benefits and insurance.
• Familiarity with Medicare Advantage concepts.
• Proficient in Microsoft Office and Excel.

Responsibilities

• Outreach to members and insurance partners by phone to verify ArchWell Health assignment and schedule 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.

Skills

MS Office

Excel

Patient care

Medicare Advantage

Diversity communication

Education

High school diploma or GED

Tools

eClinical Works

EMR systems

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.