Member & Provider Services Representative Job at Tristar Insurance
JOB LOCATION:
Candidates must live near our Las Vegas, NV Location. Must be willing to be in office for training.
This position will be primarily a remote based position with the exception of:
- Training,
- In person required attendance for meetings, projects/activities, or events (if applicable)
- Job related and required business travel (if applicable),
- When remote system interruptions occur beyond the employee’s control and a TBA office is available for the employee to continue the work on a temporary basis,
- When business circumstances/operations change that warrant the employee to work from a TBA office, if available, on a more regular or frequent basis
Working remotely, on a permanent basis, is not a guarantee for this position.
POSITION SUMMARY: Under general supervision, this position is responsible for creating a positive member and provider experience by providing a superior level of customer service. The Member and Provider Services Representative supports, develops and maintains service relationships with all client members and providers.
DUTIES AND RESPONSIBILITIES:
Effectively communicate and explain all benefit plan provisions.- Answer incoming calls from providers that have inquiries about eligibility and benefits, claims or authorizations on member’s accounts.
- Accurately assist in member plan benefit information and checking medical benefit coverages or exclusions to ensure member and providers are accurately informed.
- Accurately document all conversation outcomes in the system in order to ensure an accurate record of the communication with participants and providers is archived.
- Effectively operate, access and manage resources available in the claims systems.
- Coordinate with other departments to ensure provider and member claim issues are timely resolved as applicable.
- Ensure supervisor is kept abreast of member or provider issues and escalate concerns to supervisor for guidance or handling as applicable.
- Manage and respond to all member and provider calls in a professional manner while answering questions timely and correctly.
- Regular attendees in accordance to hours of operations are essential functions of the job.
- Other duties as assigned
EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire required when conducting business with internal/external personnel remotely or in person.
QUALIFICATIONS REQUIRED:
Education and/or Experience:
- High school diploma or GED required and the following:
- Minimum one year customer service experience; preferably in the medical field
Other Qualifications:
- Preferred Bilingual (Spanish and English)
Knowledge, Skills and Abilities:
- Knowledge of multi-line telephone
- Excellent organizational and multi-tasking skills
- Intermediate computer skills
- Advanced written communication skills (typing (55+ wpm), grammar, spelling, correspondence drafting, etc.)
- Knowledge of office equipment (fax, copier, etc.)
- Highly detail oriented, excellent problem solving skills, ability to consistently meet minimum production standards, and positive attitude towards staff and customers
- Ability to adapt to change
- Excellent communication skills both verbal and written
- Ability to work independently as well as being a team player
- Must be knowledgeable in all aspects of member plans and benefits
- Demonstrated understanding of confidentiality as it may relate to participants and co-workers
Here are some of the benefits you can enjoy in this role:
- Medical, Dental, Vision, Disability & Life Insurance
- 401(k) plan
- Paid time off
- Paid holidays
Mental and Physical Requirements:
MENTAL AND PHYSICAL REQUIREMENTS
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects
- Visual requirements necessary to perform the job:
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
2. PHYSICAL EFFORT (cont.)
FREQUENCY
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
X Kneeling: Bending legs at knee to come to a rest on knee or knees.
X Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
X Reaching: Extending hand(s) and arm(s) in any direction.
X Standing: Particularly for sustained periods of time.
X Walking: Moving about on foot to accomplish tasks, particularly for long distances.
X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm.
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Frequently
Frequently
Occasionally
2. PHYSICAL EFFORT (cont.)
FREQUENCY
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.
Frequently
Frequently
Frequently
3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
WORKING CONDITION
ENVIRONMENTAL
FACTOR
NATURE/REASON
OF EXPOSURE
FREQUENCY
Dirt/Dust
Noise
Temperature extremes
Dampness
Vibrations
Equipment movement hazard
Chemicals/solvents
Electrical shock
Significant work pace/pressure
Odors/Fumes
Other (specify):
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