Member Services Representative

The Member Services Representative communicates with members via incoming calls to efficiently and effectively answer membership questions regarding benefit eligibility, performs outreach communications and handles all inquiries within the scope of the position’s responsibility.

• Respond to Member calls in a courteous and professional manner, answering questions and inquiries regarding membership eligibility, benefits, claims, notice of actions or adverse benefit determinations, grievance processes, policies and procedures. Completes forms and other paperwork as needed, and document all incoming and outgoing calls.
• Educate members on the guidelines of their dental benefits with the company and their insurance partners. Understand and clearly communicate Willamette Dental Group systems, processes, policies and treatment services to members.
• Assess and resolve problems within the scope of authority; escalates complex questions or problems to more experienced representatives or higher authority level.
• Identify complaints and understand how to facilitate the process with the Practice or Member Services Grievance, Appeal and Care Coordination.
• Supports various outreach programs
• Work independently and function well in a team oriented environment.

High School Diploma or equivalent and two years of customer service experience in a high volume call center; or any equivalent combination of education and/or experience which leads to the ability to perform the essential functions of the position. Experience in communicating benefits to members with diverse backgrounds and cultures preferred.

Knowledge of:

• Dental terminology and procedures.
• Standard office equipment including personal computers, database entry and Microsoft suite of applications to communicate and convey information.
• Oregon Administrative Rules (OARs) and regulations overseen by Centers for Medicare and Medicaid Services (CMS) relating to services provided by Willamette Dental Group and timelines necessary to ensure compliance.
• Insurance policies, contracts and consumer rights.

Skill In:

• Verbal and written communications and being able to diffuse difficult conversations.
• Decision-making, problem-solving and organizational agility.
• Keyboarding including 10 key.

Ability to:

• Provide outstanding customer service.
• Identify complaints and understand when to escalate call to other team members.
• Maintain clear and open lines of communication between the Practices and Member Services.
• Understand and clearly communicate to members how to access and utilize plan benefits.
• Demonstrate cultural competency and interact with members from very diverse backgrounds and cultures.

We provide:

• A stable, dentist-owned private company with an eye on the future.
• Excellent benefits including:
  • Paid time off
  • 401k $1 for $1 match up to 5% of your compensation or the IRS limit for 401(k) contributions, whichever comes first
  • Medical, dental, life and disability insurances
  • Tuition reimbursement
• A culture of inclusivity and respect in line with our core values of health, compassion, innovation and integrity.
• Supportive community outreach dollars and encouragement to volunteer.
• Thorough employee orientation and onboarding.

We are:

• A provider and employer of choice in the Northwest for 50 years.
• Dental insurance providers in over 50 general and specialty offices in OR, WA and ID.
• Dedicated to proactive care to facilitate the best possible outcomes.

We evaluate qualified candidates without regard to race, color, religion, sex, national origin, veteran status and other protected characteristics.

This job description is not meant to be an all-inclusive list of duties and responsibilities, but constitutes a general definition of the position’s scope and function in the company.

This position may be exposed to PHI in the course of his/her duties, and will handle protected information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).