Note: The job is a remote job and is open to candidates in USA. NationsBenefits is a healthcare fintech provider of supplemental benefits, flex cards, and member engagement solutions for managed care organizations. The Member Services Representative handles member and provider inquiries about benefits, claims, eligibility, and health plan information while researching issues, providing accurate assistance, and maintaining regulatory compliance.
Responsibilities
- Answer inbound calls from members and providers regarding health plan benefits, claims, eligibility, and general inquiries
- Research, locate, and provide accurate information while ensuring a positive customer experience
- Resolve member service issues by identifying concerns, researching solutions, implementing appropriate resolutions, and escalating complex issues when necessary
- Review and analyze claims to identify key elements and processing requirements based on diagnosis codes, procedures, provider information, medical policies, contracts, and established polices and procedures
- Educate members and providers on benefits, coverage, and health plan processes
- Identify members who may benefit from care management or managed care interventions and collaborate with clinical staff to facilitate appropriate services
- Document all interactions accurately and thoroughly in accordance with company policies and regulatory requirements
- Maintain compliance with HIPAA and all applicable healthcare regulations
- Meet productivity, quality, attendance, and customer satisfaction standards
Skills
- · Strong computer and data entry skills
- · Excellent verbal and written communication skills
- · Strong problem-solving and critical-thinking abilities
- · Ability to multitask and navigate multiple systems simultaneously
- · Attention to detail and commitment to accuracy
- · Ability to work independently and as part of a team
- · Professional demeanor with a strong focus on customer satisfaction
- · High School Diploma or GED required
- · Previous call center or customer service experience preferred
- · Working knowledge of Medicare and Medicaid programs preferred
- · Minimum of one (1) year of customer service or call center experience preferred
- · Healthcare, insurance, Medicare, or Medicaid experience preferred
Benefits
- Remote work (any location)
- Career advancement opportunities from within the organization across multiple locations in the US, South America, and India
Company Overview