Member Service Representative

Ormond Beach, Florida
Health & Social Care, Practitioner & Technician (Healthcare Practitioners and Technical Occupations)
Job Type
Temp to Perm
Working Hours
8:00 AM - 5:00 PM
US$ 11.00 - US$ 12.11 per hour
Ref. Number
Pantoja, Victoria, Spherion
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Job Description

This position requires proficiency in answering calls, responding to emails, online chat, and in person support related to inquires, complaints, and appeals. Must be timely and proficient in documenting all communication. Must be accurate in researching benefits and assisting members in understanding their plan.

Responds in a timely manner, not to exceed the State of Florida Statues, Medicare Regulations and Accreditation Standards
Work as a team to assure maximum coverage of the Department
Act as a member advocate, while at the same time presenting and justifying the Organization's actions in relationship to the individual Grievance.
Is familiar and adheres to the compliance plan, and all HIPPA regulations
Respond appropriately to member complaints/inquiries
Correctly explain all inquiries regarding individual benefits package.
Accurately determine reason for call.
Documents calls in system using appropriate codes, grammar and spelling.
Ability to triage calls to appropriate person.
Maintains electronic case files in the approved format.
Identifies, intervenes, documents, and reports all potential quality/risk management issues,

Working hours: 8:00 AM - 5:00 PM

Excellent verbal and written communication skills required.
Must be able to type a minimum of 30 words per minute with 90% accuracy.
Proficient with Microsoft Word/Outlook and basic keyboarding skills required.
Working knowledge of ICD-9 and CPT coding preferred.
Must be able to work independently and with others in a multi-disciplinary team environment.
Strong problem solving, organizational and time management skills necessary.
Must be able to diffuse difficult situations.
Must be flexible in meeting the demands of all department operations.
Must be capable of multitasking.
Multilingual is a plus.

High School

1-4 years

Comprehensive understanding of Benefits' and Patient Rights is preferred.
Knowledge of Medical Terminology preferred.
High School Diploma and 2 years of college preferred
Two years of experience with a Managed Care Organization preferred.
Two years of experience in the health care industry, preferably in public relations, customer service, or compliance/state & federal regulations preferred.

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.

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