Member Service Representative I

Cascade Comprehensive Care Inc•Klamath Falls, OR

10d

About The Position

This position interacts with members and providers, analyzes inquiries, and provides clear, accurate information in a timely manner. It documents member contacts in appropriate data systems and supports members with benefits, coverage, eligibility, authorizations, claims, and continuation-of-coverage processes. The role requires accurate data entry, research and follow-up, confidentiality, reliable attendance, effective communication, and collaboration with coworkers and other departments.

Requirements

High school diploma or GED, and two to four years of related experience and/or training, or an equivalent combination of education and experience.
Advanced basic computer job skills, including logging on to systems, communicating by email, composing documents, entering database information, creating presentations, downloading forms, and preserving or backing up important data.
Proficient and accurate typing skills.
Excellent organizational skills and ability to prioritize multiple tasks.
Strong communication skills, including presentation, persuasion, and negotiation skills, and the ability to communicate effectively and remain calm and courteous under pressure.
Ability to maintain confidentiality and comply with HIPAA rules and regulations.

Nice To Haves

Bilingual in Spanish.

Responsibilities

Provide clear and concise benefit information and answer benefit coverage questions.
Assist members and provider partners with authorizations, assignments, eligibility, and claim status; research inquiries that require information beyond what is readily available in internal and external member data systems.
Document calls clearly and concisely in required data systems.
Analyze member and provider inquiries and determine steps for resolution.
Ensure member information is accurate and assist members with redetermination processes for continuation of coverage.
Conduct research, follow up, and provide status updates to members as calls are processed and resolved.
Relay information to appropriate departments and personnel using established communication procedures.
Initiate welcome touch point calls to new members.
Enter data accurately into various programs and balance multiple tasks by organizing and prioritizing work.
Maintain confidentiality and comply with HIPAA rules and regulations.
Maintain punctual, regular, and predictable attendance; collaborate with the team; communicate effectively and remain calm and courteous under pressure; and take direction from the manager.