Entry Level Member Services Representative (Bilingual Preferred) at Detroit

Job Description

• Conduct inbound/outbound telephonic contact with members in a professional manner and maintain phone stats according to departmental goals
• Educate members and providers on members benefits, rights and responsibilities
• Educate members and providers on MHP policies and procedures regarding access to care, grievance and appeal process and eligibility process
• Consistently demonstrates compliance with HIPAA regulations, professional conduct and ethical practice
• Provide “CMC Factor" customer service to members, providers, and internally to all Caidan Management Staff
• Act as a liaison between providers and members on all issues
• Remain updated on all member and provider policy changes made by MHP or the State
• Welcome new members to MHP monthly and ascertain member medical needs to ensure a smooth transition to the MHP network
• Performs accurate data entry into MHP systems and software programs
• Understand and be able to maneuver through the MHP member handbook
• Work with transportation and PCP office to schedule members’ appointments as needed

• Make appropriate referrals to other departments when necessary

• Assist members through Live Chat

• Process Member Data Changes, State File Changes, and Member Services Faxes in a timely fashion

• Perform other duties as assigned

Job Requirements

High school diploma is required. Pursuit of Associate’s degree, Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) or job-related certification is preferred. Six months to one year of customer service experience or related health care industry experience is required. Candidates must be fluent in Spanish as well as English. Basic knowledge of managed care or Medicaid programs is helpful. Familiarity with Medical Terminology is preferred.

Country: USA, State: Michigan, City: Detroit, Company: Meridian Health Plan.