Member Services Representative

Medical Associates-posted 7 months ago
Full-time • Entry Level
Remote • Dubuque, IA
Ambulatory Health Care Services
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If you are looking for a customer service based position that has a variety of clerical duties, offers a flexible schedule, and the opportunity to work from home if desired, your search is over! Medical Associates Health Plans is looking for a full-time Member Services Representative to join our team!

  • Respond to phone, in-person, written or e-mail inquiries from members, employers, brokers, providers, pharmacies as well as internal customers, in accordance with department standards.
  • Perform research on inquiries and resolve; educate members on benefits, Explanation of Benefit forms, the use of the website and other tools and documents utilized by members.
  • Possess knowledge and ability to communicate to internal and external customers regarding benefit plans, including medical, prescription drug and other employee benefit plans offered.
  • Interpret and enter necessary data and documentation into member and authorization subsystems of core business processing system as necessary to support the member services department; possess knowledge to examine, process, calculate and administer claims according to internal processing guidelines.
  • Assist in review and resolution of complaints, appeals and grievances as needed.
  • Complete all additional assigned projects and duties.
  • One to three years of similar or related experience.
  • High school diploma or GED required.
  • Excellent telephone presence.
  • Familiar with Microsoft Office applications, particularly Word and Excel.
  • Single or Family Health Insurance with discounted premium rates for wellness program participation.
  • 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
  • Flexible Paid Time Off Program (24 days off/year)
  • Medical and Dependent Care Flex Spending Accounts
  • Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.
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