Member Services Representative II -KSPA Kelsey-Seybold Clinic

Kelsey-Seybold; Town of Texas (WI); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading company in the health sector is seeking a Member Service Representative II to provide exceptional service to health plan members. The role involves addressing inquiries, promoting member retention, and utilizing software applications for claims and benefits management. This position is crucial for ensuring high-quality service and support for Medicare Advantage plan members.

Responsibilities

• Provide Concierge Service to health plan members.
• Resolve inquiries from members, providers, and customers.
• Utilize software applications for administrative issues.

Job description

Responsibilities

Member Service Representatives II-KSPA provide Concierge Service to members of the health plan, including delivering high-quality service to callers, making outreach calls to provide information on health plan policies, collecting responses for surveys, and promoting member retention and growth initiatives. They resolve inquiries from members, providers, and customers, exceeding productivity, quality, and service standards. They quickly learn and utilize software applications to address administrative issues related to claims resolution, premium billing, medical benefit interpretation, organization and coverage determinations, referral and prescription drug inquiries, and enrollment/disenrollment activities. They handle calls for our Medicare Advantage plan, interpret Medicare policies, and support chat conversations and outbound calls for appointment scheduling and disenrollment reasons.