Member Services Representative - Grand Rapids, United States - ASR CORPORATION

Description

We are a health plan benefit administrator seeking to hire individuals that have the desire to grow with us.

We are looking for an experienced Member Services Representative (MSR) provides specialized call management, advocacy and education to members while fulfilling the mission of excellent customer service.

The MSR guides and supports the members through their various issues while working closely within our claim units to facilitate timely issue resolution and ensure a positive member experience.

Responsibilities (include but are not limited to):

• Manage assigned member caseload via high-touch advocacy model with a focus on elevating the member experience and promoting engagement.
• Handle and coordinate elevated internal and external member issue resolution with confidence and a sense of urgency. Act as point person for member inquiries, issues, and concerns.
• Direct, quarterback and ensure timely issue resolution and remediation.
• Facilitate, influence and coordinate communication with members, staff, providers when needed, escalate to Supervisors when needed if it extends to legal representation.
• Establish and build a strong rapport with members and internal counterparts.
• Maintain accurate and complete documentation and followup diaries during all stages of the process.
• Collaborate with other internal staff as assigned to address service issues and process/systemic enhancement opportunities.
• Act as Claims Processor if required to resolve the call.
• As a claims processor validate the information on medical, dental, vison, flex, HRA claims and assist with Healthcare Choices and Rewards.
• Review notes to file to ensure that there is no missing or incomplete information.
• Resolve day to day claim issues.
• Ability to identify Replacement Claims, Duplicate Claims and Late/Additional Charges
• Ability to link specified claims to appropriate contracts.
• Proofread all manual entered claims.
• Strong Verbal and written communication skills.
• Establish priorities, meet deadlines and work independently with limited supervision.
• Ability to multitask and prioritize tasks with other internal departments to meet company goals.
• Able to meet daily production goals and performance objectives.
• Adhere to HIPAA guidelines and regulations.

Required Experience / Education

• High School Diploma or GED required.
• Experience in delivering clientfocused solutions based on caller's needs.
• Proficiency in Microsoft Outlook, Microsoft Word, Excel, and internet navigation
• Experience in billing, insurance, healthcare, or legal environments a plus
• Ability to multitask and thrive in a fastpaced entrepreneurial company.
• Excellent written and verbal communication skills
• Knowledge of UB04 and CMS1500 billing forms
• Proficient in Microsoft Outlook, Word, and Excel

Required Experience

Two or more years in a Claims Processing, Data Entry, or Customer Service environment with TPA or Insurance Company providing employee benefit health care coverage.

Must have demonstrated record of success.

ASR follows a hybrid work structure where employees can work remotely or from the office, as needed, based on demands of specific tasks or person work preferences.

There are times when working in the office will be required based on the specific task or project.