Member Services Representative - Health Plans

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!

• 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

• Multitasking and effective organization
• Clear documentation
• Strong interpersonal communication and emotional maturity

• →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.

• Onsite/in-person every 5–6-week rotation for face-to-face interactions, Mon-Fri 8am-5pm
• Onsite training required for about 5 months before work from home option

Knowledge, Skills and Abilities:
Experience: One to three years in customer service, ideally in a call/phone center environment or administrative type role.

Education: High school diploma or GED required.

Other Skills: Excellent telephone presence. Familiar with Microsoft Office applications, particularly Word and Excel.