Member Service Representative Level 1

Job Description

Job Description

Description:

SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Childcare and Personal Assistant industries with the delivery of health and pension benefits. Our 50+ employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve.

Position Summary:

The Member Service Representative (MSR), Level 1, is a key member of the Member Service

call center and outreach teams, providing high-quality service and support to both plan

participants and healthcare providers. MSRs ensure that callers consistently receive high-quality customer service that reflects the Benefit Fund Office’s standards, developing trusted member and provider relations with the Fund Office.

This role functions within a high-volume call center environment and is responsible for assisting union members and healthcare providers with eligibility, enrollment, benefits, medical claim inquiries and processes, referral requirements, and navigation of the member and provider portals.

The position requires strong communication skills, attention to detail, and the ability to manage multiple priorities while maintaining exceptional service standards.

Key Duties and Responsibilities:

• Professionally handle incoming calls and inquiries from plan participants, medical providers, vendors, and medical partners for all health plans with excellent quality service.
• Follow scripts, policies, procedures, and plan documents to ensure first -call resolution.
• Able to perform in a high call volume environment with the ability to provide quality service effectively by phone, in-person, and virtually
• Resolve any open issues requested from calls, voicemail, and walk-ins while documenting all interactions accurately
• Provide translation support across departments when needed
• Meet established call center performance metrics and contribute to improvement initiatives
• Process enrollments with accurate data entry into the benefits administration system
• Use project management software (Smartsheet) to track daily requests
• Have working knowledge on the guidelines of the Fund’s nine (9) health plans while referencing appropriate summary plan descriptions
• Educate members on eligibility, covered and non-covered services, benefit options, and best practices for healthcare use
• Provide members and providers with status on claims submission process, medical claim status, benefits, eligibility, member appeal rights, referral requirements and provider reconsiderations
• Conduct proactive outreach to plan participants to provide education regarding benefits, eligibility requirements, and referral requirements
• Collaborate with internal departments and healthcare partners to identify members who may benefit from outreach or additional assistance
• Handle eligibility-related inquiries and disputes by reviewing member records, contributions, and supporting documentation to determine next steps
• Perform follow-up calls or communications with members to ensure issues have been resolved
• Track and manage member and provider requests and inquiries
• Handle network escalations within a 48-hour turnaround time
• Attend and participate in various meetings, including All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements
• Create one-on-one (1:1) agendas with the Member Service Supervisor using the Purpose,
• Outcome and Process (POP) Model and keeping thorough notes for each meeting

Privacy and Security Responsibilities:

This position requires handling Personally Identifiable Information (PII) and Protected Health Information (PHI). The MSR is responsible for maintaining the confidentiality, integrity, and security of all PII and PHI and must report any suspected identity or HIPAA violations to the HIPAA Privacy and Security Officers.

Requirements:

Education Requirements:

• High school diploma or GED
• Customer service certification preferred

Job Requirements:

• 1–2 years of customer service experience in healthcare (benefits administration preferred)
• Ability to understand and explain basic enrollment, eligibility, and benefit information
• Call center training or experience
• Typing speed of 35 wpm or higher, with accuracy
• Work a hybrid schedule, averaging 2 scheduled days in-office per week, dependent on department operations and performance
• Strong written and verbal communication skills
• Strong listening, interpersonal, and problem-solving skills
• Proficiency with Microsoft Office (Word, Excel, Outlook) and office equipment (printers, scanners, fax, etc.)
• Excellent organization, time management, and attention to detail
• Ability to meet deadlines and work independently or within a team
• Accountability and ability to work cooperatively across departments
• Flexibility to assist with special projects and handle multiple tasks

Preferred Skills:

• Basic skills in Microsoft PowerPoint
• Bilingual (Ukrainian, Spanish preferred)
• Understanding of health insurance claims, as well as an ability to analyze data to resolve provider service issues
• Experience with benefit administration systems (Bridgeway)
• Experience with Smartsheet or other project management tools
• Remote work experience (laptop provided)
• Experience with virtual conference software (Teams, Zoom)
• Awareness of labor movements, social issues, and political factors impacting the organization

Career Development & Continuing Education Opportunities: Yes

Benefits:

SEIU Healthcare IL Benefit Funds offers a comprehensive health benefits (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.

Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.