What are the responsibilities and job description for the Member Services Representative position at Willamette Dental?
Position Summary
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.
Essential Position Functions
- 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
Education and Experience
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.
Compensation
The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to education, job-related knowledge/skills, experience, geographical location, and internal equity.
This position is also eligible for incentive pay in accordance with the terms of the Company's plan.
Company Benefits
Willamette Dental offers the following benefits for this position, subject to applicable eligibility requirements: medical, dental and vision insurance, tuition reimbursement, flexible spending accounts, 401(k) retirement plan with 5% match, accidental death and dismemberment insurance, life insurance, voluntary disability insurance, commuter benefits, two complimentary pairs of Fig scrubs (clinical roles), and employee assistance program.
Paid Time Off (PTO): Eligible employees will accrue a minimum of 120 PTO hours per employment year in addition to seven paid holidays annually. The Company's PTO program combines vacation and sick leave, which is more generous than Washington State's Sick Leave Law.
Physical Requirements
The work is primarily performed while sitting and/or standing, but will require occasional walking, bending, stooping and carrying light items such as papers, books, or other supplies. The incumbent uses a computer and other standard office equipment to complete tasks.
Willamette Dental is an equal opportunity employer.
We provide equal employment opportunities to all employees and applicants for employment without regard to an individual's race (including physical characteristics historically associated with race), religion, color, age, sex (including pregnancy), national origin, veteran status, disability, marital status, genetic information, sexual orientation, gender identity, pregnancy-related condition, or any other classification protected by applicable federal, state or local laws.
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).
