Member Services Representative - Health Plans

Medical Associates; Dubuque (IA); Hybrid; USD 36,000 - 54,000; Full time

Benefits offered by this job

Health insurance

401(k) with immediate match

Flexible PTO (24 days/year)

Flexible Spending Accounts

Job summary

Medical Associates Health Plans is seeking a full-time Member Services Representative to join our team in Dubuque, Iowa. The role centers on delivering superior customer service and handling member and provider inquiries related to benefits, claims, and enrollment, with data input into processing systems.

Training occurs in the office, followed by a schedule of 8:00am–5:00pm with the option to work from home if desired. A stable weekday routine and comprehensive benefits accompany the position.

Qualifications

• One to three years of similar or related experience.
• High school diploma or GED required.
• Excellent telephone presence.
• Familiar with Microsoft Office applications, particularly Word and Excel.

Responsibilities

• Answer inbound and outbound telephone calls in a professional, courteous, and timely manner.
• Respond to member and provider inquiries regarding benefits, claims, and enrollment.
• Interpret, review, and enter member data and authorization information into core processing systems.
• Support Member Services operations and complete all assigned projects and duties.

Skills

Customer service

Verbal communication

Telephone presence

Microsoft Office

Education

High school diploma or GED

Tools

Word

Excel

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.