医疗保险会员服务代表 - Peak Health
Medicare Member Services Representative - Peak Health
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作为会员服务代表，加入西弗吉尼亚大学医学中心（WVU Medicine）的Peak Health团队，为创新的Peak Advantage Medicare计划奠定基础。Medicare会员服务代表将接听Peak Health Medicare Advantage会员和提供者的来电，回答从一般信息到各种问题的复杂查询。此职位将与Peak团队的管理层和同事合作，研究并解决会员的问题和疑问。除了接听来电外，还将主动致电会员和提供者以解决问题或收集更多信息。候选人需在周一至周五的7:30 am至8:00 pm期间工作8小时。
最低资格要求：
教育、认证和/或执照：
1. 高中毕业或同等学历
经验：
1. 一年处理Medicare索赔或相关经验
优先资格要求：
教育、认证和/或执照：
1. 相关医疗保健领域的副学士学位或更高学历
经验：
1. 在快节奏的电话环境中，有处理和/或客户服务经验三年以上
2. 三年以上Medicare福利经验
3. 两年以上CMS指南知识经验
4. 有支持双 eligibles 特殊需求计划（D-SNP）的经验，包括对Medicaid福利、护理协调、资格要求以及医保和医助服务整合以满足复杂会员需求的了解
5. 有协助会员进行D-SNP资格认定、注册流程、与福利相关的查询，以及帮助其使用医保和医助资源以确保卓越会员体验的经验
核心职责和责任：此处描述的陈述旨在描述分配到此职位的人员所从事工作的总体性质。它们不打算被解释为所有责任和职责的详尽列表。可能会分配其他职责。
1. 在解答一般问题时验证会员信息。
2. 回应并解决所有问题/查询，以确保高效的服务。
查看英文原文
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.
Come join our Peak Health team at WVU Medicine as a Member Services Representative, contributing to the foundation for an innovative, Peak Advantage Medicare plan. The Medicare Membership Services Representative will take inbound calls from Peak Health Medicare Advantage members, and providers answering questions ranging from general information to complex inquires on a wide range of issues. This role will work with management and peers on the Peak team to research and resolve member issues and questions. In addition to taking inbound calls, will make outbound calls to members and providers with issue resolution or to gather further information. Candidates should expect to work an 8-hour shift, between the hours of 7:30 am – 8:00 pm Monday – Friday.MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School diploma or equivalent
EXPERIENCE:
1. One (1) year of experience with handling Medicare claims or related experience
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Associate Degree, or greater, in related healthcare field.
EXPERIENCE:
1. Three (3) plus years’ experience in a fast-paced call environment with processing and/or customer service experience.
2. Two (2) years’ experience in Medicare benefits
3. Two (2) years’ experience in knowledge of CMS guidelines
4. Experience supporting Dual Eligible Special Needs Plans (D-SNP), including working knowledge of Medicaid benefits, care coordination, eligibility requirements, and the integration of Medicare and Medicaid services to support complex member needs.
5. Experience assisting members with D-SNP eligibility determinations, enrollment processes, benefit-related inquiries, and navigation of Medicare and Medicaid resources to ensure an exceptional member experience.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Verify member information while addressing general questions.
2. Responds to and resolves all issues/inquires to assure an efficient and seamless member experience.
3. Maintains open channels of member communications doing outreach as required.
4. Understanding of Medicare claims processing, and related inquiries.
5. Meets all production and quality standards, maintaining work queues according to department standards.
6. Effectively communicates with internal and external staff.
7. Elevates issues to next level of supervision, as appropriate.
8. Ensures accuracy of information gathered and shared on a member’s behalf.
9. Attends all required training classes, demonstrating proficiency and ability to learn.
10. Other duties as deemed appropriate by the Management Team.
11. Maintain accurate documents, including timekeeping records
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to sit for extended periods of time.
2. Ability to answer phone calls for extended periods of time.
3. Lifting 10-25 lbs.
4. Travel Requirement: 0%-25%
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
2. Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC
SKILLS AND ABILITIES:
1. Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
2. Ability to take direction and to navigate through multiple systems simultaneously.
3. Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.
4. Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
5. Familiarity with Medical insurance services process.
6. Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
7. Ability to work remotely – this includes reliability, self-motivation, focus & time management skills.
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
PHH Peak Health HoldingsCost Center:
2911 PHH Member ServicesOriginally posted on Himalayas