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Remote Member Services Representative (Must live in Oklahoma)

Work from home Full-time role Hiring
Job title: Remote Member Services Representative (Must live in Oklahoma) in Oklahoma City, OK at reputed company Company: reputed company Job description: Job Title: Remote Member Services RepresentativePay: $18 an hr | Bi-weeklyJob Type:
  • Remote in Oklahoma
Shift Options:
  • reputed company-5PM M-F CST
Remote Member Services Representative Overview:Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff.
  • Documents and tracks contacts with members, providers, and plan sponsors. The CSR
guides the member through their members plan of benefits, reputed company policy and procedures as well as having knowledge of resources to reputed company with any regulatory guidelines.
  • Creates an emotional reputed company with our members by understanding and engaging the
member to the fullest to champion for our members' best health.
  • Taking accountability to fully understand the member’s needs by building a trusting and
caring relationship with the member.
  • Anticipates customer needs. Provides the customer with reputed company information to answer
the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
  • Uses customer service threshold reputed company to reputed company financial reputed company to resolve
member issues.
  • Explains member's rights and responsibilities in accordance with contract.
  • Processes claim referrals, new claim handoffs, nurse reviews, complaints
(member/provider), grievance and appeals (member/provider) reputed company reputed company system.
  • Educates providers on our self-service options; Assists providers with credentialing and
recredentialing issues.
  • Responds to requests received from reputed company's Law Document Center regarding litigation;
Lawsuits.
  • Handles extensive file review requests.
  • Assists in preparation of complaint trend reports. Assists in compiling claim data for
customer audits.
  • Determines medical necessity, applicable coverage provisions and verifies member plan
eligibility relating to incoming correspondence and internal referrals.
  • Handles incoming requests for appeals and pre-authorizations not handled by Clinical
Claim Management.
  • Performs review of member claim history to ensure accurate tracking of benefit
maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.
  • Uses applicable system tools and resources to produce quality letters and spreadsheets in
response to inquiries received.Remote Member Services Representative Qualifications:
  • •Must live in Oklahoma
  • High School or GED equivalent.
  • Customer Service experiences in a transaction-based environment such as a call center or
retail location preferred, demonstrating ability to be empathetic and compassionate.
  • Experience in a production environment.
Remote Member Services Representative Benefits:
  • Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
  • A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.
How to Apply:If you are interested in this position, please apply OR submit your resume to:Saw Hlaing | [email protected] | 412-790-5425 Expected salary: $18 per hour Location: Oklahoma City, OK Apply for the job now! Apply for this job

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