Member Services Representative - Health Plans

mahealthcare; Dubuque (IA); Hybrid; USD 36,000 - 46,000; Full time

Benefits offered by this job

Health Insurance

401k matching

Flexible PTO

FSA

Job summary

Medical Associates Health Plans is seeking a full-time Member Services Representative to join our team. You will handle inbound and outbound calls, assist members and providers with benefits, claims, eligibility, and billing questions, and maintain data in our processing systems.

The position offers a standard Monday–Friday schedule, with training in the office and potential to work from home after training.

Qualifications

• Experience in customer service or call center roles is preferred.
• Education: High school diploma or GED required.
• Strong communication skills and ability to navigate multiple computer programs.

Responsibilities

• Answer inbound and outbound phone calls in a professional and courteous manner.
• Respond to member and provider inquiries regarding benefits, claims, eligibility, and billing.
• Enter and review data in core processing systems and support claims processing per policies.
• Complete additional projects and duties as assigned.

Skills

Customer service

Verbal communication

Teamwork

Technology literacy

Education

High school diploma or GED

Tools

Microsoft Word

Microsoft Excel

CRM software

Job description

If you are looking for a customer service-based position that has a variety of clerical duties, offers a flexible schedule, and the opportunity to work from home if desired, your search is over!

Medical Associates Health Plans is looking for a full-time Member Services Representative to join our team!

Who You Are

• Dedicated to providing superior customer service
• Able to adapt to various customers and their needs
• Have excellent verbal communication
• Comfortable learning and navigating various computer programs and phone queues
• Excited to work closely with team members in a fast-paced environment

Work Schedule

Monday through Friday, 8:00am to 5:00pm. Training period will be in the office. After training, schedule is 8:00am to 5:00pm with opportunity to work from home if desired.

Benefits Package includes

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You'll Be Doing

• Answer inbound and outbound telephone calls in a professional, courteous, and timely manner.

  Respond to member and provider inquiries regarding:

  • Medical, dental, vision, and pharmacy benefits
  • Claims status and claims processing
  • Claim denials and appeal processes
  • Prior authorizations and referral requirements
  • Eligibility and enrollment status
  • Premium payments and billing questions
  • Provider network participation
  • Explanation of Benefits (EOBs) and Explanation of Provider (EOP's)
  • Coordination of benefits
  • Coverage limitations and exclusions

  Interpret, review, and enter member and authorization data and supporting documentation into core business processing systems to support Member Services operations. Maintain working knowledge of claims administration processes, including the ability to review, analyze, process, calculate, and adjudicate claims in accordance with internal policies, procedures, and processing guidelines.

• Complete all additional assigned projects and duties.

Knowledge, Skills and Abilities

Experience: One to three years of similar or related experience.

Education: High school diploma or GED required.

Other Skills: Excellent telephone presence. Familiar with Microsoft Office applications, particularly Word and Excel.