Member Services Representative (Medicare) at TEKsystems

Medical insurance experts needed! Please apply!

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.

·Demonstrate and maintain a thorough and complete working knowledge of appropriate information management systems, and ACD telephone system.

·Maintain good working relationships and open communication with internal and external customers.

High school graduate or the equivalent. Two-year degree in health related, liberal arts or communication field, including a course in medical terminology is preferred.

Required Experience

One year call center experience or two years customer service experience. Preference given to candidates with health insurance (HMO), physician group practice, or community agency. Proficient PC skills required knowledge of Microsoft office.

Working knowledge of medical claims and/or medical billing processes. Proficient computer skills; knowledge of Microsoft office, Amisys, and MACESS type software packages.

Required states they can sit in:

MN, IA, Wisco, KS

Experience Level:

Intermediate Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.