12 Member & Provider Services Representative Jobs in Las Vegas, NV
Tristar Insurance is Hiring a Member & Provider Services Representative Near Las Vegas, NV
Job Details
Member & Provider Services Representative
JOB LOCATION:
Las Vegas, Nevada (office-based), Hybrid, or Remote.
Bilingual English/Spanish required for this position
This position will be office-based during the required training, as applicable. Once training is complete, the position will become hybrid or remote-based subject to company remote-work policies. Working permanently on a hybrid or remote schedule is not a guarantee for this position.
POSITION SUMMARY: Under general supervision, this position is responsible for creating a positive plan participant and provider experience by providing a superior level of customer service. The Member and Provider Services Representative supports, develops and maintains service relationships with all client members and providers.
DUTIES AND RESPONSIBILITIES:
- Effectively communicate and explain all plan benefits.
- Answer incoming calls from providers that have inquiries about eligibility and benefits, claims or authorizations plan participants.
- Assist with the review of plan benefit summaries, medical coverage and exclusions to ensure plan participants and providers are accurately informed.
- Accurately document all conversations in the system to ensure all communication with plan participants and providers are archived for future reference, as needed.
- Effectively access and manage resources available in the claims systems.
- Coordinate with other departments to ensure provider and plan participant claim issues are timely resolved as applicable.
- Ensure supervisor is kept abreast of plan participant or provider issues and escalate concerns to supervisor for guidance or handling as applicable.
- Manage and timely respond to all plan participant and provider calls in a professional manner throughout the duration of the conversation.
- Immediately report to supervisor any system or equipment issues, downtimes, or when access to remote office provided resources is unavailable, to ensure supervisor initiates appropriate action and directives.
- Ensure that communication tools such as instant messaging (jabber); email, Zoom, or other available sources of communication are frequently used to stay in touch with the team, supervisors and others within the organization.
- Regular attendance in accordance with hours of operations are essential functions of the job.
- Other duties as assigned
EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire required when conducting business with internal/external personnel remotely or in person
Qualifications
QUALIFICATIONS REQUIRED:
Education and/or Experience:
- High school diploma or GED required and the following:
- Minimum one year customer service experience; preferably in the medical or employee benefit administration industry.
Other Qualifications:
- Bilingual (Spanish and English)
Knowledge, Skills and Abilities:
- Knowledge of multi-line telephone
- Excellent organizational and multi-tasking skills
- Intermediate computer skills
- Advanced written communication skills (typing (55 wpm), grammar, spelling, correspondence drafting, etc.)
- Knowledge of office equipment (fax, copier, etc.)
- Highly detail oriented, excellent problem solving skills, ability to consistently meet minimum production standards, and positive attitude towards staff and customers
- Ability to adapt to change
- Excellent communication skills both verbal and written
- Ability to work independently as well as being a team player
- Must be knowledgeable in all aspects of member plans and benefits
- Demonstrated understanding of confidentiality as it may relate to participants and co-workers
Here are some of the benefits you can enjoy in this role;
- Medical, Dental, Vision, Life Insurance, Disability
- 401(k) plan
- Paid time off.
- Paid holiday.
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
| MENTAL AND PHYSICAL REQUIREMENTS | ||
| 1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. | ||
| b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. | ||
| c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. | ||
| 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects | ||
Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point | ||
| 2. PHYSICAL EFFORT (cont.) | FREQUENCY | |
| c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. | Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally | |
| 2. PHYSICAL EFFORT (cont.) | FREQUENCY | |
| X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. | Frequently Frequently Frequently | |
| 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. | ||
| WORKING CONDITION ENVIRONMENTAL FACTOR | NATURE/REASON OF EXPOSURE | FREQUENCY |
| Dirt/Dust | ||
| Noise | ||
| Temperature extremes | ||
| Dampness | ||
| Vibrations | ||
| Equipment movement hazard | ||
| Chemicals/solvents | ||
| Electrical shock | ||
| Significant work pace/pressure | ||
| Odors/Fumes | ||
| Other (specify):
|
Job Summary
Other
Insurance
$36k-45k (estimate)
02/09/2024
05/05/2024
tristargroup.net
FRESNO, CA
1,000 - 3,000
1987
Private
$500M - $1B
Insurance
Related Companies
About Tristar Insurance
TRISTAR is a provider of risk management and insurance services to businesses.
The following is the career advancement route for Member & Provider Services Representative positions, which can be used as a reference in future career path planning. As a Member & Provider Services Representative, it can be promoted into senior positions as a Customer Service Representative III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Member & Provider Services Representative. You can explore the career advancement for a Member & Provider Services Representative below and select your interested title to get hiring information.
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