Position: Temporary Member Services Enrollment Representative
Department: Member Services
Reports to: Member Services Manager
About PSHP
Few industries are growing as quickly with such a strong career outlook as health care. Puget Sound Health Partners is poised to become the local industry leader in supporting health care delivery within the 65+ market arena, and we're looking for qualified individuals to join our winning team. Our goal is to promote our members' health though local provider innovation, work as responsible stewards of health care resources and be an active partner in improving the health of our communities. We believe that experience, teamwork and accountability will help us succeed. We offer a competitive salary, comprehensive benefit package, and rewarding growth potential. PSHP is an equal opportunity employer.
Summary of Duties
The role of the Member Services Team is to build trusted relationships with our members. This is achieved in our call center, answering questions and providing certain administrative services such as assisting in and processing enrollment and disenrollment. This position is an important part of helping members to understand and receive their health benefits and getting their related claims processed and paid. The candidate must be qualified to handle customer service inquiries through to resolution.
Primary Responsibilities
Assist members with benefit plan options available to them through the enrollment process. Resolve member service inquiries related to:
Medical benefits, eligibility and claims
Pharmacy benefits, eligibility and claims
Correspondence requests
Premiums
Enrollment/Disenrollment
Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
Process enrollment forms from initial data entry to finalized status;
Work with Administrative team to ensure timely receipt of all member materials;
Help members navigate the company Web site by locating information online with the member
Contact providers offices or billing agents on behalf of an enrolled member to resolve an issue
Communicate with the Medical Management Team so they can in turn communicate with care providers on behalf of the member
Research complex issues across multiple databases and work with support resources to resolve member issues
Connect members with internal specialists for assistance when needed
Partner with Appeals Coordinator to resolve escalated issues
Required Knowledge, Skills, and Abilities
Expert in need identification, intake and listening skills
Strong verbal and written communication skills
Strong time management skills
Strong problem solving approach to quickly assess current state and formulate recommendations
Ability to translate jargon and complex processes into simple, step-by-step instructions members can understand and act upon
Flexibility to customize approach to meet all types of member communication styles and personalities
Excellent conflict management skills including:
Professionally and adeptly resolve issues while under stress
Diffuse conflict and member distress
Demonstrate personal resilience
Strong attention to detail
Strong documentation skills
Education and Training
Associate degree or equivalent experience required
Customer service background required
Healthcare experience required
Medicare or Medicare Advantage experience required.
Working Conditions
Working conditions are normal for an office environment. Hours will be evenings (approximately 5pm-8pm) and weekends (approximately 8am-8pm) .
Location
Federal Way, Washington
- Location: Federal Way
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