Member Services Rep. II

Job Description

We are looking for a dedicated Member Services Representative II to join our team in Pearland, Texas. As a Member Services Representative II, you will deliver exceptional service to health plan members by addressing their inquiries, providing detailed information about policies, and promoting member engagement. The Member Services Representative II also support Medicare Advantage plans, manage appointment scheduling, and assist with various administrative tasks to enhance member satisfaction.

Responsibilities:

· Provide Concierge Service to members of the health plan which include providing a high level of service to callers and making outreach calls to members to provide information regarding health plan policies obtain responses to various required surveys and promote member retention and growth initiatives.

· Member Service Representatives resolve inquiries from health plan members providers and various customers while consistently exceeding productivity quality and service standards.

· Quickly learn and put into practice software applications to respond to administrative issues related to health plan operations including claims resolution premium billing medical benefit interpretation organization and coverage determinations referral inquiries Prescription Drug inquiries and enrollment/disenrollment activities.

· Member Service Representatives II handles member and provider calls for our Medicare Advantage plan and have demonstrated ability to interpret Medicare Policy and Procedures including but not limited to Late enrollment penalty low income subsidy enrollment/disenrollment guidance Medicare beneficiary protections and Medicare coverage rules.

· Support KelseyCare Advantage chat conversations and make outbound calls to assist with scheduling member appointments and to determine disenrollment reasons.

· 5 years’ experience in a health care or health plan insurance environment

· Knowledge of health Care and insurance and the ability to Interpret/Apply Medicare Prescription Drug Benefits, Medical Benefit Interpretation

· Knowledge of health Care and insurance and the ability to Interpret/Apply CMS Regulations, Texas Department of Insurance Regulations and ERISA

Fully remote