18 Member Service Representative Level 1 (Denver, CO) Jobs in Denver, CO
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Member Service Representative Level 1 (Denver, CO)
$36k-43k (estimate)
Full Time | Investment Management
10 Months Ago
BeneSys, Inc. is Hiring a Member Service Representative Level 1 (Denver, CO) Near Denver, CO
Member Service Representative Level 1 (Denver, CO)
Summary
Performs a variety of clerical duties. Provides support to the department coordinators, supervisors and manager to accomplish various routine and special projects. Maintains and organize department supplies. Assist with posting payments, special mailings, and record review. Ability to process Qualified Medical Child Support Orders. Assist with member walk-ins.
Primary Responsibilities
Level I
- Ability to address member inquiries, questions and concerns in all areas including basic eligibility, claims, health care benefit interpretation, proper referrals and required authorizations for medical care.
- Provides available information upon request and escalates issues as appropriate to Supervisor and/or Manager.
- Ability to communicate clearly with accurate information to callers (members/providers) either by telephone, electronic messaging, or face to face interaction.
- Retain records of calls by documenting these calls in the appropriate systems for tracking.
- Ability to multi-task, respond to questions correctly, accurately and resolve the issue from initial contact with caller.
- May be assigned to phone agent, Portal and/or web Support duties (live calls or written correspondence).
- Good solid base knowledge of essential healthcare terminology and understanding of healthcare benefits, definitions, and applications.
- Ability to diffuse irate calls to a level where the caller is satisfied with the response and resolution is offered to completion.
- Ability to provide accurate claims' status and provide claims' resolution within an acceptable turnaround time.
- Ability to work well in a Team environment and also independently.
- Good working knowledge of Microsoft suites: Excel/Word document.
- May be assigned special projects.
- Ability to assist with calls/inquiries on different plans that might not directly be administered from the office the rep is located at.
Level Il
- Ability to meet all Level I skills.
- Able to consistently meet the minimum electronic messaging responses and responds to questions thoroughly and accurately.
- Assist with more challenging healthcare benefit/claims' questions.
- Ability to handle elevated and escalated calls with minimal assistance and bring these issues to complete resolution without requiring assistance from Unit Lead and/or Supervisor.
- Ability to translate and expound on healthcare benefits and claims' status providing additional information that may help assist with resolving Member issues.
- Ability to review and respond to Provider inquiries, including 1st/2nd level Appeals from a Provider of Service.
- May be asked to do special projects within the department.
- May be asked to provide direction to other staff members, i.e.: MSR Level 1.
Level III
- Ability to meet all Level I and II skills.
- Thorough understanding of all Plans, Ability to write up more challenging or higher level of difficulty Appeals (Pharmaceutical, dental, medical, vision and benefit clarifications).
- Knowledgeable in handling group benefit issues, ability to interpret Plan guidelines.
- Ability to analyze plans and interpret benefit language contained in Plan documents, Plan announcements and other materials that are available for review.
- Good overall understanding of claims' processing guidelines to assist in resolving claims' issues and able to translate these issues clearly for resolution.
- Good internal technical ability to assist other Team members with internal/external systems.
- Fielding elevated issues from the Team and assessing the problem and attempting to resolve them prior to referring to the Supervisor or Manager if necessary.
- Good overall knowledge of department processes, guidelines, and necessary documentation requirements.
- Proficient skills in MS Word, Excel, and Outlook.
Level IV
- Is responsible for handling overflow calls for the entire department due to necessity and absences within the department.
- Will be available to assist team with basic benefit and claims questions.
- Responds and assist with Member Service Representative questions regarding Plan benefits and claims' status and other related questions that may arise.
- Assist with training within department and new representatives.
- Assist in handling difficult calls prior to transferring to Supervisor/Manager.
- Responds to internal departmental inquiries related to healthcare and claims.
- Knowledge of department procedures and guidelines.
- Good “people skills" for building relationships with colleagues at all levels.
- Ability to plan and prioritize workload and assist the department with day-to-day issues.
- Other related responsibilities can be assigned as the need arises within the department.
Qualifications
Required Qualifications:
- High School diploma or GED
- Excellent customer service skills are a must
- Must speak clearly and professionally
- Ability to understand directions and follow them to completion of requested task
- General math skills
- Ability to apply common sense to carry out detailed written or verbal instructions
- Must be able to maintain composure with difficult callers
- Ability to work independently as well as in a team
- Must be able to multi-task
- Must be detailed oriented
- Regular and predictable attendance is an essential function of this job
Work Schedule
Full time, Monday - Friday, 7:30am - 4:00pm. Required in office (no at-home days).
Competitive Benefits and Compensation Package
- Vacation time earned at a rate of .833 hours monthly
- 12 paid holidays
- 9 paid sick/personal days
- 3 days paid bereavement leave
- Medical, dental, and vision insurance, with option for dependent coverage
- Life and AD&D insurance
- 401k with employer match
- Career development opportunities
Pay
The current pay rate for this position is $23.70 per hour. This is a union position. Pay rates are determined by the collective bargaining agreement and may be dependent on education, experience, and other business factors.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees’ successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO
Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Investment Management
SALARY
$36k-43k (estimate)
POST DATE
06/24/2023
EXPIRATION DATE
06/04/2024
WEBSITE
benesysinc.com
HEADQUARTERS
TROY, MI
SIZE
100 - 200
FOUNDED
1979
TYPE
Private
REVENUE
$10M - $50M
INDUSTRY
Investment Management
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About BeneSys, Inc.
BeneSys provides administration and information technology services to trust funds.
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