Member Services Customer Service representative

*ATTRACTIVE PAY AND IMMEDIATE START*

• Provides excellent customer service while responding to customer requests via phone, fax or email
• Handles member and health plan phone calls with professionalism and courtesy at all times
• Maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
• Advises health plans, members, providers, and Management of progress made towards resolution of member complaints, grievances, and appeals and advices of any problems encountered
• At all times acts in accordance with all applicable federal, state regulations
• Accurately and completely documents ALL Member communications, appeals and grievances using Patient Center or other documentation system.
• Answers incoming calls within standard time-frames on the toll-free and TTY phone lines.
• Answer incoming calls from Health Providers, Health Plans and members requesting status updates and information on Claims, Authorizations Eligibility
• Demonstrates excellent telephone etiquette at all times.
• Transfer incoming calls to appropriate departments when applicable
• Identifies, researches, and resolves any Member issues/inquiries regarding Claims, Eligibility, Authorizations for Service, etc. promptly and responds to member with complete information.
• Make outbound calls for follow up on various member matters.
• Verifies member eligibility as needed and/or requested on individual health plan sites
• Meets department goals and expectations
• Attend all mandatory company or department t meetings
• Documents all department productivity