Member Service Representative Level 1

Job Description

Job Description

Description :

POSITION TYPE : Hourly, Non-Exempt

BARGAINING UNIT : Bargaining Unit

WORK ENVIRONMENT : Hybrid

SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with the delivery of health and pension benefits. Our 50 employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance to one another to carry out our shared mission and common agreements for those we serve.

Position Summary :

The Member Service Representative (MSR), Level 1, is part of the Member Service call center and outreach teams. The MSR ensures the quality of customer service provided to our plan participants meets or exceeds the highest standard of the Benefit Fund Office. The MSR provides administrative and professional customer service support to union members enrolling in a health plan and educating members about the health plans. The MSR must consistently and accurately document each call and resolve any inquiries related to enrollment, eligibility, healthcare benefits, and status of medical claims administered by the Benefit Fund Office.

This position will work closely with team members in and outside of the Member Service Department. Communication with both internal and external stakeholders and providing excellent customer service is vital for this role.

The Member Service Representative, Level 1 will be responsible for the following :

Key Duties and Responsibilities :

• Professionally handle incoming calls from plan participants, medical providers and vendors for all health plans.
• Provide excellent quality service and act with professionalism towards all stakeholders, especially in service to union members
• Follow the required phone scripts, policies, procedures, and plan documents to provide exceptional customer service for first call resolution; log each inquiry into the benefit administration system and document the call type, referral code and thoroughly documented notes to support the call.
• Provide service in a high call volume environment, with proven ability to provide quality assistance to plan participants in a variety of ways : in-person, over the phone, and virtually.
• Resolve open issues, whether received by call, voicemail, or in-person with a clear action plan to resolve and communicate progress and status.
• Provide interdepartmental and intradepartmental translation support.
• Maintain the required call center metrics and make call center improvement recommendations to enhance overall call center environment and caller experience.
• Maintain knowledge of enrolling eligible members into health plans based on the guidelines of the summary plan descriptions of at least twenty-one (21) different health plans.
• Process project software (Smartsheet) requests daily.
• Process enrollment with accurate data entry into the benefit administration system.
• Provide accurate benefit plan information to all members and medical providers; understand the differences in all plan benefit options, covered services, and information on in-network facility locations.
• Educate members on eligibility requirements and best practices when using plan benefits.
• Provide plan participants and providers with medical claim status, and appeal and reconsideration rights.
• Submit participant status (cancellations, death notifications and enrollments), via project software (Smartsheet).
• Provide pre-service benefits and basic claim information to providers to help understand patient’s responsibility based on the correct benefit plans.
• Provide and receive constructive feedback at the individual and group level, to peers and management.
• Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements
• Create meeting agendas using the POP’d agenda model and use the standardized note taking process.

Privacy and Security Responsibilities :

This position requires employees to handle Personal Identifiable Information (PII) and potentially Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer.

Requirements :

Education Requirements :

Job Requirements :

Preferred Skills :

Career Development & Continuing Education Opportunities : Yes

Benefits :

SEIU Healthcare IL Benefit Funds offers comprehensive health benefits (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.

Diversity creates a healthier atmosphere : SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.

2025 Pay and Benefits IL.pdf