The GA Member Specialist has the primary responsibility of supporting our GA members to ensure customer satisfaction, member retention, and compliance.
- Answers verbal, written and in-person inquiries from GA Members regarding the Medicare Plan benefits, claims, prescription benefits, policies, and procedures.
- Answers claims and finance questions, including requesting review and reassessment of any errors.
- Answers incoming telephone inquiries and resolves member complaints within the timeframes outlined in the Centers for Medicare and Medicaid service standards
- Maintains excellent documentation of member inquiries, which provides detailed information of each inquiry, including the resolution of the inquiry. Documents all member inquiries in the QNXT system.
- Provides ongoing education to GA Members about the Medicare Plan benefits, policies, procedures, providers, and pharmacies.
- Coordinates the resolution of GA Member inquiries with other departments at Martin’s Point.
- Assists GA members with Primary Care Provider (PCP) changes.
- Mails materials regarding GA upon request
- Updates the member/patient database by entering, verifying, or correcting demographic data of persons requesting information, assistance or complaint resolution.
- Updates Caremark database to reflect accurate eligibility and LIS status for members with prescription benefits.
- Delivers service in a courteous, friendly and professional manner, to both internal and external customers
- Ensure that CareMark Rx issues regarding spend, authorization, process, verification of eligibility, and setting up mail order process are resolved in a timely fashion.
- Mentors new and temporary GA Member Specialists
- High school diploma or equivalent.
- 2+ years experience in the area of customer/member services; preferably in a healthcare setting.
- Excellent customer service skills
- Ability to work efficiently and independently.
- Analytical skills in research and problem resolution.
- Strong computer skills (keyboard proficient, quick data entry with a high level of accuracy).
- Able to work cooperatively with other departments.
- Multi-task oriented with the ability to prioritize.
- Detail oriented.
- Well organized with excellent follow up skills.
- Ability to handle crisis situations and easily adapt to change.
Martin's Point Health Care - 2 years ago