Member Support Specialist

Rhode Island Commerce; Cincinnati (OH); On-site; USD 26,000 - 29,000; Full time

Job summary

Custom Design Benefits, a third-party administrator that manages healthcare benefits for self-funded clients, is seeking a customer service professional in Cincinnati, OH.

Responsibilities include educating members and providers on plan benefits, handling calls, documenting in the claims tracking system, and escalating issues when needed.

Qualifications

• Knowledge of healthcare benefits and claims processes.
• Strong communication and documentation skills.
• Ability to educate members/providers on plan benefits.
• Experience with claims tracking systems is a plus.

Responsibilities

• During the course of answering incoming calls, educate members/providers on plan benefits and claim transactions accurately and professionally.
• Ensure dissatisfied caller issues are escalated and addressed within 2 hours of receipt.
• Document all calls in the claims call tracking system.
• Document member/provider records accurately with all pertinent information.
• Completes adjustment requests and submits to appropriate personnel for next steps.
• Utilizes multiple software and digital tools timely and effectively to retrieve member or provider information for calls, emails, or letters.

Job description

• Base Pay $19.00 - $21.00 / Hour
• Industry Employee Benefits, Customer Service, Healthcare
• Employee Type Full Time Non-Exempt

Contact information

• Email [e-mail]

Description

Are you looking for a career, not just a job?

At Custom Design Benefits, we are a team built with CARE – Commitment, Accountability, Respect & Integrity, and Excellence. We are a third-party administrator who manages healthcare benefits for our self-funded clients.

Tasks:

• During the course of answering incoming calls, educate members/providers on plan benefits and claim transactions accurately and professionally.
• Ensure dissatisfied caller issues are escalated and addressed within 2 hours of receipt.
• Document all calls in the claims call tracking system.
• Document member/provider records accurately with all pertinent information.
• Completes adjustment requests and submits to appropriate personnel for next steps.
• Utilizes multiple software and digital tools timely and effectively to retrieve member or provider information for calls, emails, or letters.