Detailed Job role -
Membership Rep 1
Build the possibilities. Make an extraordinary impact!
The Membership Representative will be responsible for enrollment and billing activities of assigned accounts. Respond to incoming/outgoing calls and providing customer service to plan members, providers, and employer groups by answering benefit questions, resolving issues, and educating callers.
How you will make an impact:
• Verifies enrollment status, makes changes to records, research, and resolves enrollment system rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail.
• Ensures accuracy and timeliness of the membership and billing function.
• Responds to inquiries concerning enrollment processes.
• Maintains enrollment database and order identification cards.
• Determines eligibility and applies contract language for each case assigned.
• Performs error output resolution for electronic eligibility and processes error discrepancy list.
• Bills, collects premiums, and reconciles payments.
• Maintains and reconciles premium bill, self-bill, and individual billed accounts.
• Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
• Screens all forms and data for all paperwork received for new group and/or group re-classing benefits.
• Screens group for benefits to determine if existing or new, recognizing when benefits are not standard and handling as appropriate.
• Documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Performs basic job functions with help from co-workers, specialists, and managers on non-basic issues.
• To perform the tasks outlined above, ability to gain access to the Medicare Advantage Prescription Drug (MARx) system or similar system will be required.
Minimum Requirements:
Requires a HS diploma or GED and related experience; or any combination of education and experience which would provide an equivalent background.