Remote Member Services Representative (Must live in Oklahoma)
Job title: Remote Member Services Representative (Must live in Oklahoma) in Oklahoma City, OK at A-Line Staffing Solutions
Company: A-Line Staffing Solutions
Job description: Job Title: Remote Member Services RepresentativePay: $18 an hr | Bi-weeklyJob Type:
Remote in Oklahoma
Shift Options:
8AM-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, Aetna policy and procedures
as well as having knowledge of resources to comply with any regulatory guidelines.
Creates an emotional connection 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 related information to answer
the unasked questions, e.g. additional plan details, benefit plan details, member self-service
tools, etc.
Uses customer service threshold framework to make financial decisions 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) via target system.
Educates providers on our self-service options; Assists providers with credentialing and
recredentialing issues.
Responds to requests received from Aetna'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 Now
Company: A-Line Staffing Solutions
Job description: Job Title: Remote Member Services RepresentativePay: $18 an hr | Bi-weeklyJob Type:
Remote in Oklahoma
Shift Options:
8AM-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, Aetna policy and procedures
as well as having knowledge of resources to comply with any regulatory guidelines.
Creates an emotional connection 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 related information to answer
the unasked questions, e.g. additional plan details, benefit plan details, member self-service
tools, etc.
Uses customer service threshold framework to make financial decisions 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) via target system.
Educates providers on our self-service options; Assists providers with credentialing and
recredentialing issues.
Responds to requests received from Aetna'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 Now