Member Services Representative

Job Overview

Description

If you are looking for a customer service based position that has a variety of clerical duties, offers a flexible schedule, and the opportunity to work from home if desired, your search is over!

Medical Associates Health Plans is looking for a full-time Member Services Representative to join our team!

Who You Are:

• Dedicated to providing superior customer service
• Able to adapt to various customers and their needs
• Have excellent verbal communication
• Comfortable learning and navigating various computer programs and phone queues
• Excited to work closely with team members in a fast-paced environment

Schedule: Monday through Friday, 8:00am to 5:00pm for training period. 

Location: Position is located at Medical Associates Health Plans, 1605 Associates Drive. Opportunity for work from home after training if desired!

Benefits Package is Worth Over $20,000 and includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
• Flexible Paid Time Off  Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You'll Be Doing:

• Respond to phone, in-person, written or e-mail inquiries from members, employers, brokers, providers, pharmacies as well as internal customers, in accordance with department standards. Perform research on inquiries and resolve; educate members on benefits, Explanation of Benefit forms, the use of the website and other tools and documents utilized by members.
• Possess knowledge and ability to communicate to internal and external customers regarding benefit plans, including medical, prescription drug and other employee benefit plans offered
• Interpret and enter necessary data and documentation into member and authorization subsystems of core business processing system as necessary to support the member services department; possess knowledge to examine, process, calculate and administer claims according to internal processing guidelines.
• Assist in review and resolution of complaints, appeals and grievances as needed.
• Complete all additional assigned projects and duties.

Knowledge, Skills and Abilities:
Experience: One to three years of similar or related experience.

Education: High school diploma or GED required.

Other Skills: Excellent telephone presence. Familiar with Microsoft Office applications, particularly Word and Excel. 

Physical Aspects:

Stooping - Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

Reaching - Extending hand(s) and arm(s) in any direction.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Vision - 20 / 40 or better in the best eye with or without correction.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Environmental Conditions: None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.

Please view Equal Employment Opportunity Posters provided by OFCCP here.