Salary $918 a week job type full-time
Full job description
Shift: day job
Your talentOur visionAt anthem, inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communitiesJoin us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of america`s leading health care companies and a fortune top 50 company.
Member service representative (must live within a commutable distance to wixom)
Due to the current covid-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the expectation that you will return to a regular, in-office work environmentAs we continue to monitor guidance from cdc and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities
Job title: member service representative (must live within a commutable distance to wixom)
Exemption status: non exempt
Reports to: manager, member services
Job code: st918 salary grade: union – grade 4
General summary: answer subscriber and provider questions about benefits, eligibility, claims and certificationEnsure customer satisfaction and promote a positive corporate public imageScreen incoming subscriber and provider calls/inquiries and take data to initiate casesQuote accurate benefit and policy information regarding inpatient and alternative levels of careHandle complicated inquires and educate providers/subscribers in the certification process and reconcile inconsistencies and procedural difficulties when necessary perform all data entry for case initiation and update and enter data into system for non-participating providersSpecial projects and all other duties as assigned.
Duties and responsibilities
1Perform responsibilities and tasks in ways that promote good will, build positive relationships, preserve human dignity and contribute positively to the corporation service orientationService calls in a professional and courteous mannerPerform review of service requests for completeness of information.
2Answer telephone calls identifying those needing case management services, those needing referral to routine outpatient services, and those needing authorization and/or verificationAnswer questions from providers, members, insurance carriers and/or beacon regional officesCertify benefits per account specific guidelinesProvide list of in-network providers to callersExplain benefits and benefit maximums that have been reachedVerifies benefits against contract requirements prior to case initiationRefers complicated cases to case managersCollect and transfer non-clinical dataAcquire structured clinical dataPerform activities that do not require evaluation or interpretation of clinical data.
3Attend all staff meetings, team conferences and in-service as directedComply with all credentialing and other pso requirementsAssist to train new unit personal and to set up new clinical case management units as directedAssist in special projects as directed by the department manager/supervisorAssist clinical area managers to prepare for re-authorization of services by gathering necessary information and retrieving relevant subscriber filesAssist to maintain subscribers’ filesAssist clinical case managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility and researching provider information.
4Record complaints, grievances and appeals.
5Collects demographic data from providers/subscribers for case initiationCompletes data entry for authorizationsPerform data entry for case initiation and updatesResearch and investigate claims inquiriesDocument all inquiries.6Apply beacon policies and procedures consistentlyMaintain confidentiality of clients, business records and reportsMaintain ethical and professional standardsMaintain individual productivity and performance standardsMeet departmental expectations, accuracy, productivity, and performance standardsSupport beacon in achieving mission statementAdhere to the components of the compliance programEnsure that job tasks are performed in a legal and ethical mannerActively assess work area for non-compliance issues and notify supervisor or call ethics hotlineAdhere to compliance training requirements and understand that training is required condition of employmentComplete tasks accurately and within required timeframes.
Bachelors’ degree in social work, psychology or equivalent in a related health care field.
A minimum of one year of customer service experience or experience in the behavioral health care field.
Strong customer service orientation, and excellent written and verbal communication skills especially telephone service skills requiredAll applicants will be required to demonstrate their customer service skills by participating in a test phone call simulation.
Must demonstrate ability to quickly summarize telephone conversations and accurately input to a computerMust demonstrate ability to maintain a professional demeanor during a crisis situationExcellent time management and organizational skills needed.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, incHas been named as a fortune 100 best companies to work for®, is ranked as one of the 2020 world’s most admired companies among health insurers by fortune magazine, and a 2020 america’s best employers for diversity by forbesTo learn more about our company and apply, please visit us at careers.antheminc.comAn equal opportunity employer/disability/veteranAnthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all anthem positions.