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    Member Services Representative - Sacramento, United States - Insight Global

    Insight Global
    Insight Global Sacramento, United States

    2 weeks ago

    Insight Global background
    Description


    The Member Services Representative will be responsible for fielding incoming phone calls from customers with inquiries on their account, website, and other non-technical issues.



    Day to Day:
    A client of Insight Global is looking for Level 1 and Level 2 Member Service Representatives who will be responsible for the following:


    • Resolve incoming calls concerning members' eligibility, benefits, provider information, monthly premium billing, medical claims billing, status and clinical and pharmacy need
    • Coordinate member plan needs from changing a Primary Care Provider to assisting with clinical or pharmacy related matters
    • Accurately document and direct appeals and grievances according to department protocols and procedures and may help with research and resolution
    • Research and validate claims and/or billing issues, and follows department procedure and policies to resolve these issues within set timelines
    • Reviews and analyzes member claims for accuracy as well as educate members on how benefits are applied


    We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day.

    We are an equal opportunity/affirmative action employer that believes everyone matters.

    Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances.

    If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to .

    To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:
    .

    Required Skills & Experience


    Must Have:
    * 2+ years of Call Center experience within a Healthcare OR Health Insurance environment


    • Must be comfortable going onsite 5 days a week, after 6 months there is potential for a hybrid role, but it will be based on performance (3 days onsite / 2 days remote)
    • Advanced knowledge and experience with healthcare terminology such as HMO, insurance information, benefits, provider information etc.
    • Data entry experience and intermediate computer skills
    • Flexible schedule to occasionally pick up shifts within these time frames after 5-6 months M-F 7am8pm, SatSun 8am6pm after fully trained
    Nice to Have Skills & Experience


    Plus:

    • Experience validating claims and billing issues (Level 2)

    Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching.

    Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.

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