Member Services Representative II 

• Provide Concierge Service to members of the health plan which include providing a high level of service to callers and making outreach calls to members to provide information regarding health plan policies, obtain responses to various required surveys and promote member retention and growth initiatives. 
• Resolve inquiries from health plan members, providers, and various customers while consistently exceeding productivity, quality and service standards. 
• Proven ability to quickly learn and put into practice software applications to respond to administrative issues related to health plan operations including claims resolution, premium billing, medical benefit interpretation, organization and coverage determinations, referral inquiries, Prescription Drug inquiries and enrollment/disenrollment activities. 
• Handles member and provider calls for our Medicare Advantage plan and have demonstrated ability to interpret Medicare Policy and Procedures including but not limited to Late enrollment penalty, low income subsidy, enrollment/disenrollment guidance, Medicare beneficiary protections and Medicare coverage rules.
• Support chat conversations and make outbound calls to assist with scheduling member appointments and to determine disenrollment reasons

• Five (5) years of experience working in a healthcare insurance environment. 
• Knowledge of HMOPOS and TPA Plan Design and Claims Processing. 
• Ability to interpret/apply Medicare Prescription Drug Benefits and Medical Benefits Interpretation.
• High School diploma or GED is required. 
• Must pass knowledge testing and maintain positive quality and production scores. 

• Work Schedule: Monday – Friday, 8:00 a.m. – 5:00 p.m., with no weekends to offer a good work/life balance.
• During employment with Team1Medical Staffing, you can enroll in our benefits program, including medical         (3 plans to choose from), dental, disability, critical illness, life, vision, accident, and behavioral health insurance. Additional benefits include 401K, direct deposit, and our referral bonus program!