Member Services Representative

Minneapolis, MN

Member Services Representative

Humera is seeking a Member Services Representative located in Minneapolis. Our client delivers high-quality health coverage and services to help members of all ages. The individuals in this role is responsible for accurately applying knowledge of the client's business, products, members and operations to effectively fulfill member service requests and inquiries. Ensure adherence to all policies and procedures and meet/exceed service levels by following established guidelines and standards. This is a long term contract position.

Duties

  • 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.
  • Attend department and other meetings as requested.
  • Other projects and duties as assigned.

Requirements

  • High school graduate or the equivalent required.
  • Two-year degree in health related, liberal arts or communication field, including a course in medical terminology.
  • One to two years 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 is preferred.
  • Proficient computer skills; knowledge of Microsoft office, Amisys, and MACESS type software packages.

Post Date: 01.10.2019

Salary: Contact for Rate

Shift: 1st

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If you would prefer to speak directly to a Humera Staffing Consultant, please call us at 612-977-1440 and reference OrderID 816325


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For more than 45 years you may have known us as Dolphin Staffing - a name synonymous with quality temporary, and direct hire employment in the Minnesota. Today we are Humera - a boutique staffing agency that specializes in the placement of the best and brightest administrative and professional talent for contract, contract to hire and direct hire opportunities. Although we have changed our name, we continue to provide flexible career opportunities across a broad range of industries and with companies large and small. We invite you to become part of our elite workforce today!

Humera Administrative and Professional Staffing is an Equal Opportunity Employer.