Member Services Representative II
Location: Pearland Administrative Office
Department: KS Plan Advantage-Operations
Job Type: Full Time
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.
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)
High School Diploma
Associates or Bachelor’s Degree
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
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.
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.
“EPIC” Tapestry Experience
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.