Member Services Representative - Health Plans in Irving, TX

Summary:

This position is to provide service and support to our managed care customers through verbal or written communication. This position acts as the primary liaison both telephonic and in-person between all members and the plan.

Responsibilities:

• Facilitates member & provider understand of the plan coverage and benefits by thoroughly researching inquiries in an efficient and professional manner
• Records all contact with customers, both verbal & written in the current MIS system
• Required to assist in training/re-training new and current employees
• Maintains accurate documentation of all telephone contact, walk-in customers, any mail inquiries by documenting to ensure a clear audit trail for reporting purposes
• Responsible for handling all incoming calls and the making of outgoing calls as needed in order to resolve any issues or questions
• Triage phone request to other areas such as Utilization Management and Provider Relations
• Handles incoming written correspondence in a timely and professional manner
• Must have excellent understanding of benefits, products, & other health care and/or insurance issues as they pertain to our customers (internal/external)
• Excellent communication and knowledge of MIS system
• Including but not limited to Microsoft Word and Microsoft Excel

Requirements:

• High School Diploma

Work Type:

Full Time

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