Member Service Unit Representative

VillageCareMAX

112 Charles Street, New York, NY 10014

COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE!

Essential Job Functions:

• Facilitates communication between members, subcontractors, providers and Care Managers
• Handles member, vendor and provider requests for information and member materials
• Responsible for administrative duties including processing faxes, scanning and mailing
• Maintains and updates member records with pertinent information as necessary
• Provides plan information to new members, family members or other representatives as requested
• Assists members with accessing translation services
• Participates in special projects in response to program needs
• Backs up the Member Services queue as required by operations, answering inbound calls and routing to the appropriate responsible parties
• Resolves same day grievance complaints where possible
• Other duties as assigned

Role Competencies:

• Industry Understanding - Knowing the key concepts and variables of healthcare provider services and payment (including Medicaid and Medicare).
• Planning & Organizing - Identifying goals, objectives, methods, resources needed to carry out methods, responsibilities and dates for completion of tasks.
• Problem Analysis - Ability to detect problems, recognize important information, and link various data; to trace potential causes and look for relevant details.
• Evaluating with Tact - Assesses issues objectively, recognizes preconceptions and takes distance from sensitiveness. Diplomatic and 'organization-sensitive'. Can handle emotionally-charged subjects, taboos, and intercultural differences.
• Coordinating and Controlling Resources - Monitoring and adjusting resources and processes to achieve goals and objectives in a highly effective and efficient fashion.
• Integrity & Commitment - Reliable and, in word and deeds, upholds VillageCare code of conduct and compliance. Accounts for actions with valid arguments, properly directs own activities, and can self-correct.
• Communication Skills - Stimulates effective communication between individuals and groups that attempt to solve differences of opinion and conflicts. Able to communicate effectively in writing and orally, actively and passively, person to person and in a group. Can effectively interact with senior management team, providers, and federal and state regulators.

Qualifications & Minimum Requirements:

• Education: Associates Degree

Experience: A minimum of 3 years of job-related experience. Experience in MLTC environment or Health Care a plus

Physical Requirements & Working Conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must have use of sensory skills in order to effectively communicate and interact with other employees and the public through the use of the telephone and personal contact as normally defined by the ability to see, read, talk, hear, handle or feel objects and controls.
• Manual dexterity necessary to efficiently operate office equipment. Minimal bending, carrying, kneeling, crawling, reaching, pushing, and pulling. Ability to lift up to 10 lbs.
• May be required to stand and/or remain in a stationary position for long periods of time.

VillageCare is an Equal Opportunity Employer.