Member Services Representative
Full Time
Pleasanton, CA 94566
$31.22 an hour
Posted Just posted
Job description
Member Service Representative Level 1 (Pleasanton, CA)
Summary This position responds to incoming telephone calls from client participants and providers with questions about Health & Welfare benefits. This is a union position.
Essential Duties and Responsibilities include the following:
- Positively respond to incoming calls from members and providers by, among other things:
- explaining group benefits
- addressing eligibility questions
- providing information on referrals
- describing required authorizations for medical care
- assisting with claims’ issues
- providing claims’ status
- answering questions or concerns
- resolving problems
- Submit requests for adjustments on claims, research questions and problems, and provide the best solutions available.
- Alternate with co-workers during slow periods to make sure phones are always covered.
- Make outgoing calls to members and providers.
- Alpha sorting, organizing, or other special projects.
- File forms and letters.
- Provide available information upon request and escalate issues as appropriate to Supervisor and/or Manager.
- Retain records of calls by documenting in the appropriate system for tracking.
- Other duties may be assigned.
- Reliable and predictable attendance is an essential function of this job.
Member Services Representative Levels
- Level I - Some customer service experience, some claims knowledge, good phone skills, positive attitude, medical knowledge a plus.
- Level II - Level I skills, plus complete understanding of BeneSys, Eldorado, Benefit Driven, Well Point, and Envision systems and Plan documents. Knowledge of any vendor systems that may be required to assist in calls. Ability to field 90% of calls without consulting the Unit Leader. Prepare appeals for Unit Leader review.
- Level III - Level I and II skills, plus complete understanding of all California Plans, appeals (pharmaceutical, dental and medical), ability to create class codes, complete understanding of Medicare and Medicare D. Proficient skills in MS Word, Excel and Outlook. Ability to analyze new plans for conversion and train new staff.
Supervisory Responsibilities No supervisory responsibilities
Qualifications
- Background in medical claims processing.
- Knowledge of medical terminology and understanding of healthcare benefits, definitions and applications.
- Knowledge of and capable of handling multiple group benefits.
- Ability to communicate clearly with accurate information to callers either by telephone, electronic messaging, or face-to-face interaction.
- Ability to deal with people in stressful situations.
- Ability to use good communication skills and keen observation to understand what a caller is asking for and then use good judgment to come to a resolution.
- Ability to multi-task, respond to questions correctly and accurately and resolve the issue from initial contact with caller.
- Ability to diffuse irate calls to a level where the caller is satisfied with the response and resolution is complete.
- Ability to work well in a team environment and also independently.
- Good working knowledge of Microsoft suites: Excel/Word.
Education and/or Experience - High School diploma or GED equivalent. 2 plus years in an Employee Benefits position or similar.
Language Skills - Effective communication skills are essential. Individual should enjoy and be able to work in a busy and sometimes noisy/high pressured environment.
Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication, and division.
Reasoning Ability - Representative must be analytical and have the ability to apply common sense to carry out detailed written or oral instructions. Representative must be able to deduce if a balance due is the responsibility of the member or if the plan has yet to consider the charges.
Certificates, Licenses, Registrations - None required.
Physical Demands - Occasional lifting of paperwork and batches of claims. Regular use of standard office equipment such as: computers, phones, photocopiers, fax machines, etc. Sustained periods of being on the telephone, keyboarding, sitting/standing.
Work Environment - The position operates in a typical call center environment, that, at times, can be noisy, pressured and stressful. The department can be fast paced.
Work Schedule
Full time, Monday – Friday, 8:00am - 5:00pm. Required in office (no at-home days).
Competitive Benefits
- Medical/Dental/Vision, with option for dependent coverage
- Flexible spending accounts
- Company-paid basic life/AD&D, short-term disability, long-term disability insurance
- 15 days Paid Time Off during first full calendar year
- 11 paid holidays
- Up to 5 days of paid bereavement leave
- Up to 20 days of paid jury duty leave
- 401(k) with employer match
Pay
This is a union position. The wage rate for this position is determined by the collective bargaining agreement and may be dependent on experience, skills, education and other business factors. The current starting rate for this position is $31.22 per hour.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees’ successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO
Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
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