Job Description

 Hiring Immediately!

JOB SUMMARY:

Position is responsible for answering a high volume of incoming and outgoing calls and responding to all communications coming to Member Services in the form of email, fax, letters, and phone calls.  Timely responses to all member communication are essential.  Must effectively prioritize and flex the workload as new communication and task are submitted. This role is a part of the Member Services department and reports to the Member Services Supervisor.

 Typical essential functions include but are not limited to Explaining the plans benefits, procedures, & services to:

o    Providers and employers requesting benefits, eligibility, authorization for outpatient surgery, Member’s claims concerns, or referral requests to other network providers Hospital admission and pre-admit authorization requests

o    Members with eligibility issues, COBRA, claims & other concerns regarding their coverage

o    Pharmacies with eligibility issues, drug authorization, drug co-pays, research of RX claims issues

o    Maintain follow-up on phone logs, claim research, eligibility, medical, dental, vision, and prescription plan issues

o    Review member service procedures, publications, daily for one-call member resolution

o    Maintain member satisfaction and retention via rapport building and proper identification of member, employer, provider, and service representative needs

SKILLS ASSESSMENT:

TECHNICAL SKILLS

o    2 or more years of experience in health care and claims related to position and knowledge of medical terminology

o    High School diploma required; college level course work preferred in Healthcare Administration.

o    Proficient in Outlook, Word, One Note, and Excel

o    Experience in working the following fields: Healthcare Benefits plans, Billing and Coding, Customer Service call center experience and able to answer a minimum of 50+ calls per day.

o    Must be fluent English/Spanish (reading, writing, and speaking)

COMMUNICATION, PROFESSIONAL WRITTEN AND VERBAL SKILLS

o    Active Listening and verbal skills: concentrates, understands conversations, retention, delivering feedback and organization’s message

o    Accurate and fast professional typing skills, timely response to high volume of emails, faxes, etc.

o    Communicates with everyone in a positive way and delivers feedback constructively

o    Providing details and clear notes of necessary compliance documents, trainings, and meetings

CUSTOMER FOCUSED, MEMBER-CENTRIC

o    Integrity and Trust - provides communication between departments, demonstrating credibility, trust, and support. Maintains HIPPA compliance, documents and projects in trust and integrity on behalf of company, handles confidential information with discretion, trust and integrity. Maintains discretion and confidentiality in relationships with all audiences

o    Member-centric: assist members, groups, vendors and teams with our forms, projects, and processes. Dedicated to meeting the expectations and requirements of internal and external members. Acts with member first mentality. Establishes and maintains effective relationships with members and gains their trust and respect.

o    Composure: Levelheaded, balanced and calm under pressure, mature, not easily frustrated, handles stress well

o    Compassion: Genuinely cares about team and members, ready to help, sympathetic and empathic towards others

PROCESS MANAGEMENT

o    Process Management: Flex situational workload on as needed basis within Member Services, other departments and portals and system access to Outlook, WLT, and any other program as needed.

o    Time Management: Responsible for efficiently processing emails, billing invoices from members, member questions, providers inquiries on eligibility and benefits, medical and prescription authorizations etc. Accurately complete each task with member-first mentality and a sense of urgency

o    Priority Setting: eliminates roadblocks, proactively implements current workflows by deadline

INTERPERSONAL AND PROBLEM-SOLVING SKILLS

o    Effective Communicator: communicates with internal, external groups and members through our systems and regulations with precision and care, especially with confidential information. Well informed of upcoming commitments and responsibilities, following up appropriately

o    Decision Quality: researches, prioritizes, and follows up on incoming issues and concerns makes great timely decisions based on training, experience and good judgment

o    Interpersonal Savvy: relatable to all within and outside the organization, diffuses high tension situations. Ability to build relationships with members, vendors, leadership, employees and board members

o    Solution Oriented: proactive, resourceful, provides solutions and alternatives to challenges with strong decision-making capabilities. Seeks guidance as questions arise and is resolution oriented

Company Description

TEC West Inc. specializes in providing innovative, comprehensive staffing solutions. Our expertise encompasses tailoring our service capabilities to meet each client and employee's individual needs.