Medicare Advantage Member Service Representative
Job Description
Our Medicare Member Service Representatives are responsible for addressing inbound calls from members/subscribers/providers with questions and concerns in areas including enrollment, claims, benefit interpretation, and referrals/ authorizations. Qualified individuals will possess the ability to work in a fast-paced environment and deal with challenges inherent in a call-center atmosphere. The ideal candidate is motivated and accountable to self and the team, a problem-solver, takes feedback well, has excellent people skills, a positive attitude and enjoys working with people, striving to deliver excellent customer service on each call.
Responsibilities
- Answering inbound calls to verify member coverages, benefit types, eligibility dates, and claim payment/statuses
- Estimate member’s out of pocket expenses for select procedures or services and explain member copayments
- Meet established performance goals in the areas of efficiency, call quality, customer satisfaction, first call resolution, adherence, and attendance
- Ensure compliance with BroadPath, Client, and HIPAA regulations
- Responsible for verifying member coverages, benefit types, eligibility dates, and claim payment/statuses
- Estimate member’s out of pocket expenses for select procedures or services and explain member copayments
- Meet established performance goals in the areas of efficiency, call quality, customer satisfaction, first call resolution, adherence, and attendance
- Ensure compliance with BroadPath, Client, and HIPAA regulations
Basic Qualifications
- Minimum of one year of recent experience as a Medicare Member Service Representative
- Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
- Strong computer and telephone multitasking skills including: the ability to effectively search for and type information on the computer, navigate through multiple windows and screens quickly, and inputting information accurately while keeping pace with the call
- Requires excellent verbal and written communication skills
Preferred Qualifications
- FACETs recommended, not required.
- Macess recommended, not required.
