Member Services Representative (Medicare)

TEKsystems is actively hiring for Member Service Representatives (Medicare) for an independent non-profit health plan company based out of MN! (Fully remote opportunity for residents of MN, WI, IA, and KS ONLY!) **If you are not a resident of any of the states listed, you don't qualify for this position.

Description

Job Description

This position is responsible to apply knowledge of the company's business, products, members and operations to accurately and effectively fulfill member service requests and inquiries. Ensure adherence to policies and procedures and meet service level expectations by following established guidelines and standards. Achieve fluency in at least one core product or service line

·Answer, resolve, track and document telephone calls from members, providers, internal departments, and external agencies, in a timely and professional manner. Research, resolve and communicate effectively with internal and external customers regarding member/provider concerns or issues. Educate members and external customers on policies and procedures related to members’ health care program.

·Research and resolve inquiries from internal /external customers including: Enrollment, eligibility, ID cards, clinic changes, demographic changes, benefit coverage, claims, payments, member reimbursement, and demonstrated knowledge of CAG policies, procedures, and regulations. Utilize appropriate resources to respond to member inquiries.

·Answer, resolve, track and document telephone calls from members and providers in a timely and professional manner. Interpret member eligibility and coverage through thorough knowledge of the contracts, policies and procedures. Communicate with internal departments, members, providers and other customers regarding the transportation benefit in both verbal and written form, including faxing rides to providers at the appropriate times.

·Identify trends/issues that emerge in calls/correspondence, and inform Team Lead or Supervisor. Assist in the development and communication of resolutions to internal staff, as requested

Skills & Qualifications

• High school diploma / GED
• 2+ years of call center experience, preference given to someone who has worked from home.
• Consistent work history
• Preference given to candidates with health insurance (HMO), physician group practice, or community agency
• Must live in MN, IA, KS, or WI