Remote Member Services Specialist – Health Plans

Virtual Staffing Solutions; Lewiston (ME); Remote; USD 33.000 - 42.000; Vollzeit

Zusammenfassung

Virtual Staffing Solutions is seeking a Customer Service Representative (Work at Home) for Lewiston, Maine, to assist members with plan features and benefits. You will manage inquiries, resolve issues, and educate members on coverage and appeals processes, while maintaining accurate documentation across systems.

1+ year of experience preferred. Experience in customer service, preferably in healthcare, and a quiet dedicated workspace for remote work are required.

Qualifikationen

• At least 1 year of customer service experience, preferably in healthcare, health plan, or related environment.

Aufgaben

• Works with members, providers, and staff to identify and resolve member service and retention issues; educates on plan features, benefits, and admission requirements.
• Ensures first call resolution; maintains in-depth knowledge of organization, tasks and vendor responsibilities to triage needs effectively.
• Coordinates telephonic intake and responses to clinical and non-clinical issues; escalates clinical issues as needed.
• Documents call details, actions, and education across interdepartmental systems; ensures reporting accuracy and compliance.
• Enters and reconciles data, processes service requests, and follows up to ensure timely scheduling and delivery.
• Provides education on benefit coverage, service expectations, and appeals process; maintains expertise in Health Plans and related benefits.

Kenntnisse

Customer service

Jobbeschreibung

Virtual Staffing Solutions is seeking a Customer Service Representative (Work at Home) for Lewiston, Maine, to assist members with plan features and benefits. You will manage inquiries, resolve issues, and educate members on coverage and appeals processes, while maintaining accurate documentation across systems.

1+ year of experience preferred. Experience in customer service, preferably in healthcare, and a quiet dedicated workspace for remote work are required.