Member Service Representative (Salt Lake City, UT)
Full Time
Salt Lake City, UT 84107
Posted
Job description
Member Service Representative (Salt Lake City, UT)
Summary – Responds to incoming telephone calls from client participants and providers regarding Health & Welfare benefits. Each representative will be required to answer approximately 100-125 calls per day.
Member Service Representative Levels
Level I- Some customer service experience, some claims knowledge, good phone skills, positive attitude, medical knowledge a plus.
Level II- Level I skills, complete understanding of BeneSys, Eldorado, Benefit Driven, Well Point, and Envision systems and Plan documents. Not limiting to the above systems any vendor systems that may be required to assist in calls. Ability to field 90% of calls without consulting the Unit Leader. Prepare appeals for Unit Leader review.
Level III- Level I and II skills, complete understanding of all Las Vegas Plans, appeals (pharmaceutical, dental and medical), ability to create class codes, complete understanding of Medicare and Medicare D. Proficient skills in MS Word, Excel and Outlook. Ability to analyze new plans for conversion and train new staff.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Positively respond to incoming calls from members and providers to include:
a) explaining group benefits
b) assisting with claims eligibility issues
c) claims statusing
d) assisting the callers with their questions or concerns and providing problem resolution.
- Difficult claims will be transferred to supervisor for handling.
- Employee will be expected to handle each call professionally and to the best of his/her ability. Call transferring is expected to be minimal, and a call will be transferred only if
a) the caller is requesting assistance for an area the employee is not trained in, i.e. Pension, Vacation, or
b) requires the assistance of a supervisor.
- Employee may occasionally make outgoing calls to members and providers.
- In the event of phone outages, or slow days, employee may be asked to perform other job duties. This may include alpha sorting, organizing, claim paying, or other special projects.
- It is the responsibility of the Membership Services Coordinator to make sure there is adequate phone coverage with coworkers if they are leaving their desk for any reason.
- Employee must be able to have knowledge of and handle multiple group benefits.
- Makes copies as required.
- Files forms and letters.
- Must be flexible and willing to pitch in and work together as a team member.
Supervisory Responsibilities - No supervisory responsibilities
Qualifications - Background in medical claims processing, knowledge of medical terminology, will understand reasons for denials and pended claims. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience - High School diploma or GED. equivalent. 2 plus years in an Employee Benefits position or similar.
Language Skills - Effective communication skills are essential. Individual should enjoy and be able to work in a busy and sometimes noisy pressured environment.
Mathematical Skills: Ability to apply concepts of basic addition, subtraction, multiplication, and division.
Reasoning Ability - Representative must be analytical. Representative must be able to deal with people in stressful situations. Good communication skills and keen observation. Careful attention to what a caller is asking for and then using good judgment. Ability to apply common sense to carry out detailed written or oral instructions. Ability to deduce if a balance due is the responsibility of the member or if the plan has yet to consider the charges.
Certificates, Licenses, Registrations - None required.
Physical Demands - Occasional lifting of paperwork and batches of claims. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work Environment - Noisy, pressured, stressful
Work Schedule - Full time, Monday - Friday 7:30am - 4:00pm, 30 minute lunch
Competitive Benefits & Compensation Package
- Paid Time Off (PTO)
- 15 days of PTO during the next calendar year!
- Medical, dental, vision, and life insurance
- Company paid short term disability, long term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all full-time referrals
- Competitive wages
- Annual opportunities for increases and bonuses
Pay
Pay commensurate with education and experience.
Our Culture
BeneSys wants to be a great service provider to the members we serve and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees successes. We want to be a place people want to work, feel proud of what they do and feel fulfilled both professionally and personally; creating a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients;
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues and;
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
COVID-19 Considerations
- Daily sanitation procedures in place
- Daily check-in program with rigorous contact tracing
ADA & EEO
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