We are looking for Member Service Representative - Remote / Telecommute for our client in Baltimore, MD
Job Title: Member Service Representative - Remote / Telecommute
Job Location: Baltimore, MD
Job Type: Contract
Pay Range: $20.66hr - $25.66hr
Job Overview:
The Member Service Representative handles routine benefits, claims, and general inquiries using knowledge of products, systems, and contractual provisions. The candidate provides client education, interprets contract data, supports member service objectives via telephone or written correspondence, and accurately documents all client interactions.
Additional Skills:
- 2-5 years inbound call center experience.
- The incumbent uses knowledge of products and contractual provisions to provide client education and interpret contract data and business rules, supporting business and member support objectives through telephone communication or written correspondence. Documents all client interactions according to established procedures.
- Examines member records to identify key elements and processing requirements based on established business rules, policies, and procedures. Researches, investigates, and resolves problems related to member data or records and communicates resolution clearly and effectively.
- Develops and applies an expert ability to analyze client needs to effectively interact with clients. Responds to telephone and written inquiries from internal and external customers regarding contract data.
- Provides support for the execution of enrollment transactions in accordance with contractual and medical underwriting guidelines for new clients, existing clients, and transfers to and from other health plans. Learns details of offering and administering various enrollment transactions and guides customers regarding problem resolution.
- Learns to access information from automated systems, responding to client inquiries by telephone and written communication.
- Utilizes a range of automated systems including FEPDirect, NICE, OnBase, and Advance Capture to effectively administer service.
- Possesses a passion for customer service.
- Demonstrates innovative thinking and a drive for results.
- Displays exceptional oral and written communication skills.
- Possesses independent, self-starter skills required to be a dependable and productive remote representative.
- Capable of navigating concurrently between multiple software systems with relative ease.
- Ability to interface with a culturally diverse population.
- Working knowledge of basic computer functions including Microsoft products, internet research, and email communication.
- Work experience in a quality and production-driven environment.
- Requires performance in either service or claims for a minimum of 18 months at a meets-standard level or above.
- Must have previous customer service and/or claims experience.
- Additional required experience includes use of automated systems, PC or CRT proficiency, excellent oral and written communication skills, time and organizational management, and successful project management.
- Experience performing duties that are detailed in nature, exposure to healthcare, health insurance, medical information, and direct service experience is preferred.
Software & Tools:
- MS Office Suite, Visio, Adobe Acrobat, FEPDirect, OnBase, Advance Capture, NICE.
Purpose:
The Member Service Representative I is proficient in routine benefits, claims, and general inquiries. The successful candidate possesses knowledge of systems, benefits, contracts/products, internal departmental functions, standard operating procedures, claims status, enrollment/billing, and customer inquiry follow-up.
Essential Functions:
- 25% Answers member inquiries by clarifying desired information; researching, locating, and providing information. Resolves member service problems by clarifying issues, researching and exploring answers and alternative solutions, implementing solutions, and escalating unresolved problems.
- 25% Examines claims to identify key elements and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policies and procedures. Calculates deductibles and maximums, and resolves, reports, and follows through on overpayments, underpayments, and managed care processes.
- 25% Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other plans. Learns details of offering and administering various billing transactions (e.g., direct pay, credit card payment, and debit accounting) and effectively interacts with or advises clients, group administrators, brokers, or providers on problem resolution.
- 25% Identifies clients eligible for or in need of managed care interventions and collaborates with clinical professionals in designing and implementing interventions.
Qualifications:
To perform this role successfully, the candidate must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level:
- High School Diploma or GED.
Experience:
- 1+ years of customer service, claims experience, or inbound call center experience.
Preferred Qualifications:
- Experience performing detailed duties, along with exposure to healthcare, health insurance, medical information, and direct service experience.
Knowledge, Skills and Abilities (KSAs):
- Self-starter with strong organizational and planning skills (Proficient).
- Ability to maintain effective interpersonal relationships (Proficient).
- Ability to recognize, analyze, and solve a variety of problems (Proficient).
- Excellent communication skills, both written and verbal (Proficient).
- Maintains quality customer service by following established customer service practices and responding to inquiries (Proficient).
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Benefits
Our Benefits Include:
- Medical, Dental, and Vision Insurance
- 401(k) Retirement Plan
- Health Savings Account (HSA)
- Disability Insurance (Short-Term and Long-Term)
- Life and AD&D Insurance
- Paid Sick Leave (where required by applicable state or local law)
- Supplemental Insurance Plans
- Identity Theft Protection
- Pet Insurance
- Employee Wellness Programs
- Employee Assistance Program (EAP)
- Career Growth and Professional Development Opportunities
Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.
About Cynet Systems
Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia.
As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.
