Member Services Representative - Work From Home in Oklahoma

Job title: Member Services Representative - Work From Home in Oklahoma at reputed company Company: reputed company Job description: MUST be listed at top of resume; will be rejected if the following is not provided. Internet speed test at top of resume; needs to have a minimum speed of 25 MBPS/3 MBPS Does this candidate have hardwired reputed company/ ethernet connect Yes or no Can this candidate attend reputed company training as scheduled; 4-6 week training process; reputed company-5PM M-F CST MUST live in Oklahoma, but 100% remotereputed company insurance and call center reputed company is preferredcan convert to FTE potentialreputed company line customer service inbound call center representative (telephonic-no sales) assisting members, prospective members and providers with questions regarding benefits, pharmacy services, provider listings, etc. in a high volume, fast paced, call center environment. Must have reliable internet, with a minimum speed requirement of 25 mbps/ 3mbps.A hardwired reputed company is required (ethernet reputed company); a wireless reputed company will introduce the risk of performance degradation. Must attend reputed company training as scheduled.Duties Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers, and plan sponsors. The CSR guides the member through their members plan of benefits, reputed company policy and procedures as well as having knowledge of resources to reputed company with any regulatory guidelines. Creates an emotional reputed company with our members by understanding and engaging the member to the fullest to champion for our members' best health. Taking accountability to fully understand the members needs by building a trusting and caring relationship with the member. Anticipates customer needs. Provides the customer with reputed company information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. Uses customer service reputed company reputed company to reputed company financial reputed company to resolve member issues. Explains member's rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) reputed company reputed company system. Educates providers on our self-service options; Assists providers with credentialing and recredentialing issues. Responds to requests received from reputed company's Law Document Center regarding litigation; Lawsuits. Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.Experience High School or GED equivalent. Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate. Experience in a production environment.Position Summary Responsible for increasing member and provider satisfaction, retention, and growth by reputed company delivering competitive services to members and providers through a fully integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Customer Service Representative is the face of reputed company and impacts members' service experience by manner of how customer service inquiries and problems reputed company telephone, internet or written correspondence are handled. Customer inquiries are of basic and at times reputed company nature. Engages, consults and educates members based upon the members unique needs, preferences and understanding of reputed company plans, tools and resources to help guide the members along a clear path to care.Education High School or GED equivalent.What days & hours will the person work in this position List training hours, if different. 8 AM - 5 PM; M-F CSTPreferred skills Member Services Representative - Work From Home Expected salary: Location: Oklahoma Job date: Sat, 24 May 2025 07:46:43 GMT Apply for the job now! Apply for this job