Member Services Representative_Ops

SEE how you can make adifference!  Be part of an innovative company that cares about its associates and helpsmembers enjoy the wonders of sight through healthy eyes and vision.
 

Versant Health provides vision care to 37 million members nationwide! To ensure your continued success we provide opportunities for advancement and development. Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family.

Scope and Purpose of Position

The Member Services Representative is responsible for receiving, answering, and/or resolving calls received through a Call Center.  The Call Center receives phone calls from insured's and their dependents, providers and their staff, employer/group staff, and brokers.  The MSR will use companies Claims / Eligibility database to inquire on the status of claims, ID cards, addresses, and other issues as queried by the caller.  The MSR is the primary source for issuing authorizations when eligible for services.  In addition, the MSR performs duties consistent with customer/provider service.
 

Essential Functions

• Provide timely and accurate information to basic incoming customer calls from members, providers, and other external and internal constituents including:
• Issuing authorizations
• Handling claim inquiries from providers and members
• Communicate the correct information regarding accessibility, claims status and other calls of a service nature
• Providing benefits information
• Process customer claims according to established department policies and procedures
• Checking voicemail boxes and handling customer/provider requests for:
• I.D. cards
• Authorizations
• Customer Service questions and issues
• Fulfill rapid call volume by handling the appropriate amount of calls coming into the call center daily.
• Complete Provider Relations requests for service
• Provide timely feedback to the company regarding customer service failures and/or customer/provider concerns
• Partner with Sales and Provider Relations to meet and exceed customers' expectations
• Provide excellent customer service and handle all customers in a professional and courteous manner
• Perform other related duties as assigned

Education & Experience

• High school graduate or equivalent is mandatory. Business related college courses preferred
• Two years customer service or call center experience
• Two years of experience in the health care industry or insurance environment preferred
• Strong computer and technical skills to support heavy key data entry

   HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program

We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening steps. We will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process. 

We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, age, sex (including pregnancy), sexual orientation, gender identity or expression (including transgender status), national origin, ancestry, status as a protected veteran or disabled veteran, physical or mental disability or history of disability, genetic information, marital status, or any and all other categories protected by under applicable Federal, state or local law.  

This policy extends to all associates and to all aspects of the employment relationship. Any associate who violates this policy will be subject to disciplinary action up to and including termination