Kelsey-Seybold

Member Services Representative II - KS Plan

US-TX-Pearland
1 week ago
Job ID
2017-18331
Category
Clerical/Administrative Support

Overview

Member Services Representative II

Location: Pearland Administrative Office

Department: KS Plan Advantage-Operations
Job Type: Full Time

 

COMPANY PROFILE

Kelsey-Seybold Clinic. Your Doctors for Life.

 Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 21 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.​​

 

 JOB SUMMARY

Member Service Representatives II are required to provide a high level of services to members of the health plan which include providing detail information regarding health plans benefits, assisting and facilitation of services such as appointments and  transportation, direction to providers and services associated with the member’s health plan.  Obtain responses to various required surveys and promote member retention and growth initiatives. 

 

 

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

Education

A.

High School Diploma

B.

Associates or Bachelor’s Degree

Experience

A.

3-5 years of experience   in a health care  insurance environment or 1 Year Experience as a  Member   Service Rep I at KelseyCare Advantage or    6 months – 1 year experience as a KelseyCare Advantage Health Plan   Representative or KelseyCare Advantage Sales Coordinator

 

Knowledge of health care and insurance and the ability to Interpret/Apply Medicare   Prescription Drug Benefits, Medical Benefit Interpretation, CMS Regulations,   Texas Department of Insurance Regulations and ERISA

 

B.

Previous Experience with   a call documentation system

 

Knowledge of Medical Terminology

 

Ability to Work in a Fast Paced Continuously Changing Environment

 

Knowledge of CPT and ICD9 Codes

 

Ability   to understand complex oral and written directions and technical information.

 

Licenses

A.

N/A

B.

 

Special   Skills

A.

Strong   knowledge of  HMOPOS and TPA Plan   Design and Claims Processing

 

Member   Service Representatives must build and maintain productive working   relationships with various internal and external customers to solve problems   systematically using sound business judgment.   

B.

 

“EPIC” Tapestry Experience

Other

A.

Excellent   communication and telephone etiquette, Problem Solving  and active listening skills

 

Representative   II are required to pass knowledge testing and maintain positive Quality and   Production Scores.

 

Spanish Speaker

 

 

WORKING ENVIRONMENT

Office

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed