Member Services Representative - Health Plans

If you are looking for a customer service-based position that has a variety of clerical duties, offers a flexible schedule, and the opportunity to work from home if desired, your search is over!

Medical Associates Health Plans is looking for a full-time Member Services Representative to join our team!

Who You Are:

• Dedicated to providing superior customer service
• Able to adapt to various customers and their needs
• Have excellent verbal communication
• Comfortable learning and navigating various computer programs and phone queues
• Excited to work closely with team members in a fast-paced environment

Skills Needed:

• Multitasking and effective organization
• Clear documentation
• Strong interpersonal communication and emotional maturity

Work Schedule: Monday through Friday, 8:00am to 5:00pm. Training period will be in the office. After training, schedule is 8:00am to 5:00pm with opportunity to work from home if desired, must live in Dubuque or surrounding area.

Benefits Package includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You'll Be Doing:

• Answer inbound and outbound telephone calls in a professional, courteous, and timely manner.
• Respond to member and provider inquiries regarding:
  • Medical, dental, vision, and pharmacy benefits
  • Claims status and claims processing
  • Claim denials and appeal processes
  • Prior authorizations and referral requirements
  • Eligibility and enrollment status
  • Premium payments and billing questions
  • Provider network participation
  • Explanation of Benefits (EOBs) and Explanation of Provider (EOP’s)
  • Coordination of benefits
  • Coverage limitations and exclusions
• Interpret, review, and enter member and authorization data and supporting documentation into core business processing systems to support Member Services operations. Maintain working knowledge of claims administration processes, including the ability to review, analyze, process, calculate, and adjudicate claims in accordance with internal policies, procedures, and processing guidelines.
• Complete all additional assigned projects and duties.

Additional Notes on Role:

• Onsite/in-person every 5–6-week rotation for face-to-face interactions, Mon-Fri 8am-5pm
• Onsite training required for about 5 months before work from home option

Knowledge, Skills and Abilities:
Experience: One to three years in customer service, ideally in a call/phone center environment or administrative type role.

Education: High school diploma or GED required.

Other Skills: Excellent telephone presence. Familiar with Microsoft Office applications, particularly Word and Excel.