Member Service Representatives II-KSPA provide Concierge Service to members of the health plan which include providing a high level of service to callers and making outreach calls to members to provide information regarding health plan policies, obtain responses to various required surveys and promote member retention and growth initiatives. Member Service Representatives II-KSPA resolve inquiries from health plan members, providers, and various customers while consistently exceeding productivity, quality, and service standards. Member Service Representatives II-KSPA have proven ability to quickly learn and put into practice software applications to respond to administrative issues related to health plan operations including claims resolution, premium billing, medical benefit interpretation, organization and coverage determinations, referral inquiries, Prescription Drug inquiries and enrollment/disenrollment activities. Member Service Representatives II-KSPA handles member and provider calls for our Medicare Advantage plan and have demonstrated ability to interpret Medicare Policy and Procedures including but not limited to Late enrollment penalty, low-income subsidy, enrollment/disenrollment guidance, Medicare beneficiary protections and Medicare coverage rules. MSR II-KSPA will support KelseyCare Advantage chat conversations and make outbound calls to assist with scheduling member appointments and to determine disenrollment reasons.
Job Title: Member Services Representative II – KSPA
Clinic Location: Pearland Administrative Office Building
Department: KCA Member Services
Job Type: Full Time
Salary Range: $48,755 – $60,237 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: High School diploma or GED from an accredited program
Preferred: Associates or bachelor’s Degree
Required: 5 years’ experience in a health care or health plan insurance environment. Knowledge of health Care and insurance and the ability to Interpret/Apply Medicare Prescription Drug Benefits, Medical Benefit Interpretation, CMS Regulations, Texas Department of Insurance Regulations and ERISA. Excellent interpersonal skills to interface with physicians and members of the health plan. Strong ability to actively listen to customers, probe for clarification, and provide consultative guidance based upon customers inquiries. Proven Ability to use a variety of software applications and on-line resources. Excellent written communication skills. Analytical skills to evaluate problems and recommend alternative solutions
Preferred: Previous experience with a call documentation system. Knowledge of Medical Terminology. Ability to Work in a Fast Paced Continuously Changing Environment. Knowledge of CPT and ICD9 Codes. Ability to understand complex oral and written directions and technical information.
Required: Strong knowledge of HMOPOS and TPA Plan Design and Claims Processing. Member Service Representatives must build and maintain productive
Preferred: EPIC” Tapestry Experience
Required: Excellent communication and telephone etiquette, Problem-Solving and active listening skills. Representative III are required to pass knowledge testing and maintain positive Quality and Production Scores
Preferred: Fluency in Spanish
Working Environment: Office
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance