Medicare Member Service Representative
you will provide accurate, timely responses, resolution to inquiries, and informal grievances from members, authorized parties, and other internal/external customers. The customer contact takes place via phone, written correspondence, web, fax, voice mail, or face-to-face contact and is imperative to member retention. The Medicare Member Service Representative will develop familiarity with regulatory guidance and escalate compliance concerns as appropriate.
Specific duties and responsibilities include:
High School Graduate or equivalent required. Two year degree in health related, liberal arts, or communication field preferred. Course(s) in medical terminology preferred.
- 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.
- 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.
- Demonstrate and maintain a thorough and complete working knowledge of appropriate UCare information management systems, and ACD telephone system.
- Perform and track/document outbound calls as needed.
- Maintain good working relationships and open communication with internal and external customers.
- Attend department and other meetings as requested.
- Other projects and duties as assigned.
Preference given to call center, health insurance (HMO, physician group practice, or community agency. Proficient computer skills required. Excellent written and verbal communication skills required. Ability to multi-task and work efficiently in a fast-paced environment is also required.
Six-months customer service experience in a call center environment or two-years other customer service preferred.
Working knowledge of medical claims and/or medical billing processes is preferred. Proficient computer skills; knowledge of Microsoft office, Amisys, and MACESS type software packages.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA
UCare - 18 months ago
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UCare provides more than 160,000 Minnesotans with the health coverage plans and services they need to maintain and improve their health....