Member Services Specialist

South Country Health Alliance•Medford, MN

1d•Hybrid

About The Position

South Country Health Alliance is seeking a full-time Member Services Specialist to join their team. As the primary point of contact in the Call Center, the Member Services Specialist provides accurate information and assistance to members regarding enrollment, transportation, benefit questions, coverage limits, payments, claims, and matters involving provider networks. This role may involve interaction over the phone or in person. The specialist must be available to work until 8 PM on weekdays, holidays, and be on call for weekends and holidays as needed.

Requirements

High school diploma or equivalent.
One (1) year of experience in customer service or call center.
Microsoft Office Suite experience.
Must be legally authorized to work in the U.S. (No sponsorship available).

Nice To Haves

Bilingual is preferred.
Post high school education in business is preferred.
Experience with healthcare or insurance is preferred.
Knowledge of Medicare and Medicaid rules is preferred.
Knowledge of Spanish and/or Somali languages a plus.
Ability to access interpretation services, if needed.

Responsibilities

Provides assistance to members with questions, concerns, and complaints regarding their enrollment, benefits, and/or services provided by South Country in a professional and efficient manner.
Participates in the day-to-day RideConnect program to effectively schedule member transportation requests, including intaking requests, verification of appointments, identification of cost-effective providers, outreach to providers, booking rides, confirming rides with members, and coordinating ride modifications or cancellations.
Utilizes and navigates multiple computer systems, including a cloud-based phone system, to provide service to members, ensuring procedures and workflows are followed accurately and completely.
Documents all interactions (calls, emails, and face-to-face conversations) in CRM software to ensure accurate and timely handling of audits, follow-up communications, grievances, or appeals.
Assists Community Care Connectors (CCC) and other county staff with benefit questions, locating network providers, pharmacy issues, and member materials.
Stays aware of, or obtains knowledge of, Federal, State, and County laws and rules regulating healthcare services for South Country members, including those for enrollee Grievances and Appeals, to ensure compliance and prevent member loss of coverage.
Determines when an issue needs to be escalated to a supervisor or other management personnel.
Performs other duties as assigned within the scope, responsibility, and requirements of the job.