Department:OH1CH_70502_000 Mchp-Member Service
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Job Description Details:
The Member Service Representative responds in a timely and accurate manner to all member (consumer) inquiries as received by phone, in person and in writing regarding product benefits and services.
- Receive, interpret and accurately respond to member inquiries, both verbally and in writing in ways that reflect a positive, compassionate and affirming manner.
- Consistently document and accurately code all inquiries within designated software to reflect the purpose of a consumer's inquiry and all actions taken to address and resolve their issue or need.
- Generate standard or customized letters using word processing software to generate accurate written responses to member inquiries as needed.
- Obtain and maintain a thorough knowledge of plan benefits, services and changes and be able to communicate such knowledge to consumers effectively.
- Effectively document and track actions requested from other departments addressing member inquiries or informal complaints to ensure prompt resolution of all consumer matters.
- Interact professionally and effectively with members, management and other departments in a way that demonstrates Compassion, Acceptance, Respect and Empathy in a dual role as "member advocate" and "plan representative".
- Adhere to departmental policies and procedures and to comply with applicable regulations in ways that ensure compliance with all applicable federal and state regulations.
- Demonstrate an organized and accountable approach to daily administrative responsibilities (i.e. filing; returned mail research; "Action Request" form follow-up).
- Demonstrate effective use of all departmental software and technical systems as assigned.
- Participates in appropriate training and development programs, including continuing educational requirements related sales license.
- All other duties as assigned.
- Education: Minimum of high school education with some college level studies preferred
- Licensure / Certification: State of Ohio sales license for Life, Health, AD&D insurance within 90 days of hire (not applicable to temporary position)
- Experience: Prior customer service experience required. Managed Care (HMO/PPO) knowledge and experience preferred
- Computer skills required and efficient data entry abilities necessary
- Ability to function well under pressures of a fast-paced work environment while contributing positively and supportively as a team member
- Organizational skills necessary and the ability to absorb, retain and apply new knowledge accurately and quickly.
- Familiarity with medical terminology and understanding of claim processing preferred
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.