Member Service Representative
Member Service Representative
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Job Description
Position: Member Service Representative
Location: Washington DC #REMOTE
Duration: Long term
Job Description:
- The Rep Member Service I is proficient in routine benefits claims and general inquiries. They have a general knowledge of the following: systems benefits contracts/products functions of other departments in the company standard operating procedures claims status enrollment /billing and followup to a customer inquiry.
- Education Level: High School Diploma or GED
- Experience: 1 year customer service claims experience Inbound Call Center Experience
- Experience performing duties that are detailed in nature exposure to health care health insurance medical information and direct service experience is preferred.
- Selfstarter with strong organizational skills and planning skills. Proficient
- Ability to maintain effective interpersonal relationships Proficient
- Ability to recognize analyze and solve a variety of problems. Proficient
- Excellent communication skills both written and verbal. Proficient
- Maintains quality customer services by following customer service practices; responding to customer inquiries. Proficient
ESSENTIAL FUNCTIONS:
25% Answers member inquiries by clarifying desired information; researching locating and providing information. Resolves member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
25% Examines claims to identify key elements and processing requirements based on diagnosis procedures provider medical policy contracts and policy and procedures. Calculates deductibles maximums and determining resolving reporting and following through on overpayments underpayments and managed care processes.
25% Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines generating accurate billing for policies and products purchased by new clients existing clients and transfers from other BCBS Plans. Learns the details of offering and administering various billing transactions i.e. direct pay credit card payment and debit accounting through the policyholders checking account and how to effectively interact with or advise clients group administrators brokers or providers on problem resolution.
25% Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.
Thanks & Regards
LAXMAN
KMM Technologies Inc.
CMMI Level 2 ISO 9001 ISO 20000 ISO 27000 Certified
WOSB SBA 8(A) MDOT MBE & NMSDC MBE
Employment Type
Full Time
