Member Services Representative

Boston, MA

Post Date: 10/23/2017 Job ID: 2752156 Industry: Customer Service Representative

Job Description:
  • Function as the front-line contact for all members by responding to a high-volume of incoming calls from members and prospective members
  • Respond accurately to calls related to status changes, transportation guidelines, member eligibility/managed care status, prior authorization, and pharmacy guidelines/procedures
  • Provide members with all current healthcare options available to promote member choice within the assigned network or managed care providers, using knowledge gained through training and other sources
  • Conduct a thorough health care need assessment with members, including existing and anticipated need of all eligible family members, as needed
  • Complete all related paperwork and necessary forms including enrollment forms, member requests and personal reimbursement within established timeframes and guidelines
  • Investigate all third-party resources and comply with systems and administrative requirements
  • Perform accurately all data entry function to reflect member or provider activity/transactions
  • Facilitate the resolution of non-clerical issues related to client and provider compliance/participation according to established policy and protocols
  • Conduct all interactions with members and providers in a discreet, courteous and professional manner
  • Ability to respond to and resolve customer problems/needs
  • Ability to analyze problems and develop solutions
  • Perform other duties as may be assigned by management





Job Requirements
  • Background experience in customer services, human services, health care or service-related field
  • Experience with a proven track record in meeting or exceeding performance standards, schedule adherence and job skill assessments
  • Excellent organizational, written and verbal communications skills
  • Ability to perform comfortably in a fast-paced, deadline-orientated work environment
  • Ability to successfully execute proficiency in MS Window applications, Web-based applications and the ability to utilize multiple applications simultaneously
  • Prefer knowledge or provider/insurance billing procedures and remittance advices

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