Member Service Representative, MercyCare

Customer Service Representative

Support health insurance members by answering questions, resolving complex issues, and helping patients understand their benefits, coverage, pharmacy needs, and authorization requests. This role serves as a knowledgeable resource for members and team partners while delivering excellent customer service, problem-solving support, and timely follow-up in a fast-paced call center environment.

Schedule: 40-hours per week Shift: Days

Essential Duties and Responsibilities

• Serve as a resource or Subject Matter Expert (SME) for other team members or internal members in the following areas: WI and Illinois Group EPO, HMO, PPO, POS lines of business WI and Illinois Individual Marketplace WI Medicaid WI Medicare Supplemental Insurance WI and Illinois Pharmacy Riders
• Handle escalated calls, resolving more complex member issues in a one-and-done manner
• Answer incoming phone calls from members and identify the type of assistance the member needs
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
• Assist members in navigating Mercyhealth's websites and encourage and reassure them to become self-sufficient
• Assist members in choosing a primary care physician and scheduling their first appointment or when assistance getting an appointment is asked for by the member
• Own problem through to resolution on behalf of the member in real-time or through comprehensive and timely follow-up with the member
• Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues
• Provide education and status on previously submitted pre-authorizations or pre-determination requests
• Responsible for entering all approved authorizations into the pharmacy benefit management system. Also responsible for entering overrides to ensure members receive their prescriptions promptly.
• Assist in taking premium payments from members for our marketplace line of business.
• Meet the performance goals established for the position in the areas of first-call resolution, service level, occupancy rate, percentage of calls held, redirect, attendance, NCQA required audits, and any contractual requirements (ETF, Medicaid, etc.)

Education and/or Experience

High school education preferred

Pay Range: $18.65 - $29.84

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Certification Reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

At Mercyhealth, we don't simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated care across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50
• One of Working Mother magazine's 100 Best Companies for Working Mothers
• A Top 50 Company and Top 10 Nonprofit for Executive Women