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Member Service Representative

Green Key Resources

Member Service Representative

San Diego, CA
Full Time
Paid
  • Responsibilities

    Job Description

    We are actively seeking multiple Member Service Representatives to join our insurance team in San Diego, CA ASAP! This is a call center position. 

    RESPONSIBILITIES for Member Service Representative:

    • Actively LISTENS AND PROBES CALLERS in a professionally and timely manner to determine purpose of the calls.
    • Researches and articulately communicates information regarding MEMBER ELIGIBILITY, BENEFITS, EAP SERVICES, CLAIM STATUS, AND AUTHORIZATION inquiries to callers while maintaining confidentiality.
    • Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
    • Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
    • Assist in the mentoring and training of new staff.
    • Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
    • Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help achieve its business and operational goals.
    • EDUCATES PROVIDERS ON HOW TO SUBMIT CLAIMS and when/where to submit a treatment plan.
    • Identifies and responds to CRISIS CALLS and continues assistance with the Clinician until the call has been resolved.
    • Informs providers and members on appeal process.

    Qualifications for Member Service Representative:

    • High School Diploma, GED or foreign equivalent
    • 1-2 year call center experience with a background in healthcare (provider enrollment, ELIGIBILITY, BENEFITS, EAP SERVICES, CLAIM STATUS, AND AUTHORIZATION ETC)
    • Must be a proficient typist (at least 30 WPM) with the ability to maneuver through various computer platforms/screens while verifying a variety of information simultaneously. 
    • Ability to multi-task while staying organized.

    Hours for Patient Access Representative:

    • Monday - Friday - 8 hour shift between 7a - 7p

    Advantages of this Opportunity:

    · Salary is based on experience, tenure, certifications etc. (very competitive with market place)

    Next Steps:

    If you’re interested in speaking in more detail, please apply today! We are scheduling interviews ASAP.

    Company Description

    Premier executive recruitment firm specializing in permanent placement, contract consulting, temp-to-hire and temporary staffing within the following specialty areas: accounting-finance, healthcare nursing & allied health, pharmaceutical, financial service operations, information technology, creative, hospitality, office/legal support and human resources across our offices nationwide. Our recruiters are highly-specialized consultants who only recruit within specific job disciplines. Each of our division leaders has over a decade of direct experience working in the industries they serve. The bottom line is that we understand your business, your challenges – and most importantly what it takes to source and successfully hire top talent. When you’re looking to hire people who make an immediate impact, unlock your potential with Green Key Resources.