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SalaryMember Service Representative (Salt Lake City, UT)
Summary – Responds to incoming telephone calls from client participants and providers regarding Health & Welfare benefits. Each representative will be required to answer approximately 100-125 calls per day.
Essential Duties and Responsibilities include but not limited to:
- Positively respond to incoming calls from members and providers, to include:
- explaining group benefits
- assisting with claims eligibility issues
- claims statusing
- assisting the callers with their questions or concerns and providing problem resolution
- Handle each call professionally, recognizing that a call should be transferred only if caller is requesting assistance for an area on which the employee is not trained or requires the assistance of a supervisor
- Make outgoing calls to members and providers
- Some clerical duties, including filing, copying, alpha sorting, organizing, claim paying, or other special projects
- Regular and predictable attendance is an essential function of this job
Member Service 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, complete understanding of BeneSys, Eldorado, Benefit Driven, Well Point, and Envision systems and Plan documents. Not limiting to the above systems, 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, complete understanding of all Las Vegas 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, ability to understand reasons for denials and pended claims. Must be flexible and willing to pitch in and work together as a team member.
Education and/or Experience - High School diploma or GED. Two plus years of experience 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 pressured environment.
Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication, and division.
Reasoning Ability - Representative must be analytical. Representative must be able to deal with people in stressful situations. Good communication skills and keen observation are critical. Careful attention to what a caller is asking for and then using good judgment is required. Ability to apply common sense to carry out detailed written or oral instruction is essential. 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.
Work Environment – This position operates in a typical office setting. At times, it can be noisy and is fast paced. Callers can sometimes be unpleasant.
Work Schedule - Full time. Monday - Friday, 7:30am - 4:30pm. Required in office (no at-home days).
Competitive Benefits & Compensation Package
- Paid Time Off (PTO)
- 15 days of PTO during first full calendar year!
- Medical, dental, vision, and life insurance
- Company-paid basic life, short-term disability, long-term disability, and AD&D insurances
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all successful full-time referrals
Pay
The salary range for this position is $20.00 - $22.00 per hour. Actual salary offered dependent on skills, experience, education and other business factors.
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 people want to work, feel proud of what they do and feel fulfilled both professionally and personally; creating 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 and;
- 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.
