Member Service Representative, Level 1
27 days ago
Chicago
Job DescriptionDescription: SEIU Healthcare IL Benefit Funds MEMBER SERVICE REPRESENTATIVE, LEVEL 1 JOB DESCRIPTION JOB TITLE: Member Service Representative, Level 1 REPORTS TO: Member Service Supervisor DEPARTMENT: Member Service POSITION TYPE: Hourly, Non-Exempt BARGAINING UNIT: Bargaining Unit SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with delivery of health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve. Position Summary: The Member Service Representative (MSR), Level 1, is part of the Member Service call center and outreach teams. The MSR ensures the quality of customer service provided to our plan participants meets or exceeds the highest standard of the Benefit Fund Office. The MSR provides administrative and professional customer service support to union members enrolling in a health plan and educating members about the health plans. The MSR must consistently and accurately document each call and resolve any inquiries related to enrollment, eligibility, healthcare benefits, and status of medical claims administered by the Benefit Fund Office. This position will work closely with team members in and outside of the Member Service Department. Communication with both internal and external stakeholders and providing excellent customer service is vital for this role. The Member Service Representative, Level 1 will be responsible for the following: Key Duties and Responsibilities: · Professionally handle incoming calls from plan participants, medical providers and vendors for all health plans. · Provide excellent quality service and act with professionalism towards all stakeholders, especially in service to union members. · Follow the required phone scripts, policies, procedures, and plan documents to provide exceptional customer service striving for first call resolution; log each inquiry into the benefit administration system and document the call type, referral code and thoroughly documented notes to support the call. · Provide service in a high call volume environment, with a proven ability to provide quality assistance to plan participants in a variety of ways: in-person, over the phone, and virtually. · Resolve open issues, whether received by call, voicemail, or in-person with a clear plan to action to resolve and communicate progress and status. · Provide translation support and services for plan participants as needed. · Maintain the required call center metrics, while implementing call center improvement recommendations. · Ability to navigate summary plan descriptions and develop working knowledge of several benefits and health plans. · Communicate eligibility requirements and complete enrollments of eligible members into the selected health plans based on the guidelines of the summary plan description. · Deliver on project management and ticketing request daily. · Process enrollment with accurate data entry into the benefits administration system. · Provide accurate benefit plan information to all members and medical providers; understand the differences in plan benefit options, and in-network facility locations. · Educate members on eligibility requirements, covered/uncovered services, plan options and benefits, and best healthcare practices. · Provide Plan Participants and Providers with medical claim status. As well as appeal and reconsideration rights. · Submit participant status (cancellations, death notifications and enrollments), via project management software and ticketing system. · Provide pre-service benefits and basic claim information to providers and communicate patient responsibility based on the participant’s selected plans. · Provide and receive constructive feedback at the individual and group level, to peers and management. · Share innovative ideas to enhance the overall call center environment. · Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements · Create agendas with the Member Service Supervisor using the POP’d Agenda Model, and takes notes using our standardized note taking process. · Back-up all duties of the Member Service Assistant as needed. Privacy and Security Responsibilities: This position requires employees to handle Personal Identifiable Information (PII) and potentially Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer. Education Requirements: · High school diploma or GED · Customer service certification preferred Requirements: Job Requirements: · One to two (1-2) years’ customer service experience within healthcare, preferably in benefits administration · Ability to understand and provide basic enrollment, benefits and eligibility information · Meet or exceed 97% call ratio for quality and production standards · Call center experience · Ability to type 35 words per minute accurately · Experience with desktop computers, laptop computers, printers, copiers, scanners, fax and other office equipment · Basic skills in Microsoft Office (Word, Excel and Outlook) · Excellent written and verbal communication skills · Excellent interpersonal skills at all levels of business, including effectively and clearly communicating with peers, leads, managers, executives, and external partners · Strong listener and attention to detail · Creative thinking and effective problem-solving skills · Excellent people skills and customer service orientation · Must be well organized and detail oriented with demonstrated effective time-management · Must have the ability to work independently and within a team environment · Strong accountability, with the ability to manage up and manage laterally to work cooperatively with peers and leaders · Ability to meet deadlines · Exercise clear and concise judgment · Ability and willingness to assist in special projects and handle multiple tasks Preferred Skills: · Basic skills in Microsoft PowerPoint · Bilingual in Spanish · Knowledge of the Fund’s benefit administration system (basys/Bridgeway) · Experience with project management software, such as Smartsheet · Experience working in a hybrid environment, in-person and remote · Experience with virtual conference software (Teams and Zoom) · Awareness of social and labor movements and political issues impacting the organization Career Development & Continuing Education Opportunities: Yes Benefits: SEIU Healthcare IL Benefit Funds offers comprehensive health benefits (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan. Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose. Salary $18.00-$23.21