Summary:

A Member Services Representative is responsible for providing iCircle members with exceptional customer service in a call center environment. A Member Services Representative provide accurate and efficient services to ensure that members services are delivered in a timely manner. A Member Services Representative is responsible for all documentation of member contacts received through Member Services in Electronic Health Record. Member Services Representatives Assists with clerical duties related to member documentation as needed.

Essential Job Functions:

Answer member services calls via inbound call center from members who are seeking assistance related to their member benefits. Meet speed to answer guidelines.

Respond to all inquiries consistent with confidentiality and privacy policies, and transfer/refer callers to alternate sources when appropriate (such as care management, enrollment, etc).

Print and mail member documentation as needed using printer and folding machine

Make outbound welcome calls to new members and document the contacts

Assist the Utilization Management Team by placing outbound calls for Service Approval notification approvals required by NYS Department of Health

Document all contacts with member(s) and provider(s) utilizing electronic record.

Facilitate the fulfillment of member requests for materials via mail, e-mail, tasks, etc.

Adhere to quality and accuracy standards, HIPAA compliance, timeframes, and proper procedures, ensuring errors are identified and corrected. Keeps supervisor apprised of any concerns or errors.

Document complaints in the electronic health record according to standard operating procedures .

Understand and clearly communicate to members on the MLTC benefit package, Medicaid guidelines, and processes.

Perform all assigned clerical duties such as uploading, printing, folding, mailing of member documents including mass mailings, notices, signed member documents, etc.

Perform all other duties relevant to the position as assigned by supervisor.

Knowledge, Skills, and Abilities

Ability to manage a high level of confidentiality, with strong attention to detail and ability to multitask.

Ability to perform comfortably in a fast-paced, deadline-oriented work environment.

Creative decision-making skills with proven ability to work independently in on-site location, yet collaborate, communicate, and motivate others within a team setting.

Ability to actively listen and communicate effectively, both oral and written.

Preferable to be able to type minimum 30wpm.

Must be able to complete basic skills in Microsoft Windows and Microsoft Office programs, including Excel (search and filter), Outlook (send/reply to emails attaching documents), TEAMS (utilize chat functions and join meetings), and Word (search and copy/paste).

Education and Experience:

Must be at least 18 years of age.

High School diploma required, Associates degree preferred.

Healthcare experience preferred, specifically in at least one of the following areas: call center operations, MLTC, grievance and appeals, and/or authorizations.

The listed salary range represents the organization's good faith and reasonable estimate of the range of possible compensation at the time of posting. The offered salary will be determined by: Applicant qualifications and experience, education, position specific licensing/training and departmental budgets.

CDS Life Transitions is an Equal Opportunity Employer, and as such affirms the right of every person to participate in all aspects of employment without regard to gender, race, color, religion, national origin, ancestry, age, marital status, sexual orientation, pregnancy, disability, citizenship, military or veteran status, gender expression and/or identity, or any other status or characteristic protected by federal, state, or local law. CDS Life Transitions will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities unless the accommodation would impose an undue hardship on the operation of our business. If you are interested in applying for an employment opportunity and feel you need a reasonable accommodation pursuant to the ADA, please contact us at 585-341.4600.