Member Service Rep

ATI is seeking a Member Service Rep to join our OP based cleint. There will be flexibility with hybrid or remote work, but this person must be based in the greater KC area.

This person is responsible for assisting members in understanding their health plan, claim status and answering any questions regarding their benefits, as well as accurately quoting benefits and educating providers of the health plan.

Responsibilites :

• Provides compassionate and dedicated support to ensure the member experience is in line with company values.
• Educates and assists members on various elements of benefit plan information.
• Provides the caller with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, member self-service tools, claims.
• Triages claims and escalate issues as appropriate through the system for grievances and appeals.
• Assists members in finding accepting providers and facilities that address their needs.
• Coordinate with Member Advocate for issues in relation to provider access escalations.
• Educates and gains acceptance with providers and facilities when they have questions about the health plan.
• Sets expectations and consistently follows up with communications to the member from ticket initiation to closure.
• Responds and resolves inquiries on the first call by identifying the topic and type of assistance the caller needs utilizing all resources available.
• References automated job aid tools via the computer to identify appropriate procedures when needed and research relevant rules, regulations, or procedures.
• Accurately documents, researches, and resolves all inquiries by ensuring documentation is clear and complete.
• Meets or exceeds individual and departmental quality standards / achieves performance goals.
• Adheres to, keeps current on, and utilizes all company guidelines, policies and procedures.

QUALIFICATIONS :

EDUCATION AND / OR EXPERIENCE :