Kelsey-Seybold

  • MEMBER SERVICES REP II

    Location US-TX-Pearland
    Posted Date 12 minutes ago(4/25/2018 10:11 AM)
    Job ID
    2018-18855
    Category
    Clerical/Administrative Support
  • Overview

    Member Services Representative II

    Location: Pearland Administrative Office

    Department: KelseyCare 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 19 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 provide Concierge Service to members of the healthplan 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 II resolve inquiries from health plan members, providers, and various customers while consistently exceeding productivity, quality and service standards. Member Service Representatives II have proven ability to quickly learn and put into practice software applications to respond to administrative issues related to health plan operations including claims resolution, premium billing, benefit interpretation, and enrollment issues. Member Service Representatives II handles member and provider calls for all lines of insurance business including Medicare Advantage, Self Funded and Fully Insurance Commercial plans and have demonstrated ability to interpret Medicare and Texas Department of Insurance regulations and related health plan Policy and Procedures.

     

     

    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

     

    Excellent interpersonal skills to interface with physicians and members of the health plan. Strong ability to actively listen to customers, probe for clarification, and provide consultative guidance based upon customers inquiries.

     

    Proven Ability to use a variety of software applications and on line resources

     

    Analytical skills to evaluate problems and recommend alternative solutions

    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

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