Member Services Representative

Member Services Representative

If you are looking for a customer service-based position that has a variety of clerical duties, offers a flexible schedule, and the opportunity to work from home if desired, your search is over! Medical Associates Health Plans is looking for a full-time Member Services Representative to join our team! Who You Are:

• Dedicated to providing superior customer service
• Able to adapt to various customers and their needs
• Have excellent verbal communication
• Comfortable learning and navigating various computer programs and phone queues
• Excited to work closely with team members in a fast-paced environment

Work Schedule: Monday through Friday, 8:00am to 5:00pm. Training period will be in the office. After training, schedule is 8:00am to 5:00pm with opportunity to work from home if desired.

Benefits Package includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You'll Be Doing:

• Answer inbound and outbound telephone calls in a professional, courteous, and timely manner.
• Respond to member and provider inquiries regarding:
• Medical, dental, vision, and pharmacy benefits
• Claims status and claims processing
• Claim denials and appeal processes
• Prior authorizations and referral requirements
• Eligibility and enrollment status
• Premium payments and billing questions
• Provider network participation
• Explanation of Benefits (EOBs) and Explanation of Provider (EOP's)
• Coordination of benefits
• Coverage limitations and exclusions
• Interpret, review, and enter member and authorization data and supporting documentation into core business processing systems to support Member Services operations. Maintain working knowledge of claims administration processes, including the ability to review, analyze, process, calculate, and adjudicate claims in accordance with internal policies, procedures, and processing guidelines.
• Complete all additional assigned projects and duties.

Knowledge, Skills and Abilities: Experience: One to three years of similar or related experience. Education: High school diploma or GED required. Other Skills: Excellent telephone presence. Familiar with Microsoft Office applications, particularly Word and Excel.

Physical Aspects: Stooping - Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. Reaching - Extending hand(s) and arm(s) in any direction. Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles. Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling. Grasping - Applying pressure to an object with the fingers and palm. Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly. Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts. Vision - 20 / 40 or better in the best eye with or without correction. Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers. Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Environmental Conditions: None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.