Member Services Representative

Manitoba Blue Cross•Winnipeg, MB

3d•Hybrid

About The Position

Manitoba Blue Cross is a Manitoba-based, not-for-profit, health benefits provider with a vision to be the trusted and essential health and wellness partner for all Manitobans. Every dollar made is reinvested in our infrastructure, our people, and our province with the goal of providing better care for our members, expanding our community impact and broadening our health care knowledge. Manitoba Blue Cross is a Manitoba Top Employer. We are empowered to give back to the community, and we know that caring needs to start in our workplace with our own Manitoba Blue Cross team. We actively foster a culture that focuses on your satisfaction, development, diversity, and growth. We strive to succeed at reaching our organizational goals, but we always make time to celebrate our successes. Having fun as a group and rewarding our employees for their accomplishments is an essential part of our workplace culture. We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace. We offer a work environment that promotes a healthy work-life balance and support to advance your career. The position encompasses both responding to diverse and complex inquiries from customers in person and by telephone, as well as assessing, adjudicating, and processing claims. The incumbent requires extensive knowledge of all of the company’s products and administrative practices relating to company procedures.

Requirements

Dedicated to the principles of exceptional service; committed to responding to, anticipating, and addressing customer needs, for both internal and external customers
Post-secondary education in Business Administration or a related field (University degree or Community College diploma), or an equivalent combination of education and relevant experience.
Proven ability to provide high-quality customer service while maintaining accuracy in data entry and documentation.
Excellent written, verbal, and interpersonal communication skills, with strong active listening and relationship-building capabilities.
Strong attention to detail, with the ability to maintain accuracy and confidentiality in a service-driven environment.
Well-developed organizational and time-management skills, with the ability to manage multiple priorities and meet deadlines in a fast-paced setting.
Ability to remain composed and professional under pressure, demonstrating flexibility, patience, and sound judgment.
Strong problem-solving, analytical, and numerical skills, with the ability to assess situations and identify appropriate solutions.
Ability to work effectively both independently and collaboratively within a team environment, with the flexibility to adapt to changing priorities.
Strong computer proficiency, including Microsoft Word, Excel, and email applications, with the ability to learn new systems quickly.
Several years of experience providing direct service to members, clients, or the general public in a professional setting.

Nice To Haves

Experience in member services, insurance, healthcare, or a related customer-focused industry is considered an asset.
Knowledge of health benefits, pharmacy, medical products, dental services, and related terminology, or completion of a medical certificate program, is considered an asset.
Proficiency in a second language is considered an asset.

Responsibilities

Respond to a variety of customer inquiries adhering to the principal of first call resolution wherever possible. Inquires can include: Enrollment and billing procedures, Claims procedures and claims payments, Coverage information, Plan specific inquiries related to Ambulance/Hospital, Extended Health, Travel, Dental, Health Spending Account, Wellness Spending Account and Vision Care.
Confirm coverage, explain benefits and ensure claim requirements are explained and understood by both members and providers.
Check for processed claims for dental offices, hospitals, pharmacies, and various other health providers and members, including resolution of any issues and performing any corrective action.
Accurately complete an inquiry ticket for each call received and complete forms and memos as needed.
Accurately adjudicate and process standard and diverse Ambulance/Hospital, Extended Health, Dental, Health Spending Account, Wellness Spending Account and Vision Care claims and pre-authorizations in accordance with performance standards.
Assist in the management of pended claims in the Claims Workplace as assigned.
Ensure claims/queries for clients with Service Level agreements are adjudicated within the standards set out in the agreement.
Manage and update Coordination of Benefits (COB) information, ensuring the correct adjudication of claims.
Return claims for completeness of information and communicate with members and providers to obtain any necessary additional information whenever possible.
Remain current and knowledgeable about benefits which are provided by the Provincial Health Care Plan, particularly in respect to prescription drugs, travel health and vision care.
Process Bonds of Indemnity for lost or stolen cheques, distribute explanation(s) of benefits, process or forward requests for address changes and identification cards for members to the appropriate department.
Promote and sell Travel products.
Assist members with registration and navigation of the online portal.
Accept and forward customer suggestions and complaints about all aspects of Blue Cross, including billing and enrollment, claims, products and/or benefits.
Forward possible leads for group health business to the Sales department.
Forward possible leads for individual health business to the Individual Products team.
Prepare for and deal effectively with customers who contact our office following radio programs, newspaper articles, mass mailings, etc.
Assist the Customer Service Centre with in-person inquiries as required.
Assist with replying to customer emails if required.
Assist in directing customers to the appropriate source (i.e.: Government Agency) when the information does not pertain to Blue Cross.
Assist Travel Agents and General Agents in selling, extending and refunding Travel Health, Trip/Holiday Cancellation and the Tour Package Plan as well as explaining coverage information and claims procedures.
Maintain an awareness of changes to employer group plans in order to respond to customer inquiries.
Accurately adjudicate and process standard health and dental claims.
Manage and update Coordination of Benefits (COB) information, ensuring the correct adjudication of claims.
Return claims for completeness of information and communicate with members and providers to obtain any necessary additional information whenever possible.
Remain current and knowledgeable about benefits which are provided by the Provincial Health Care Plan, particularly in respect to prescription drugs, travel health and vision care.
Mail and administrative duties (sorting, scanning, indexing, document management).
Perform other duties as assigned.