Essential Functions

Direct communications with members, providers, and health plans

Confirmation of benefits and eligibility information to members, providers, and health plans

Provide confirmation of participating providers in the network

Provide claim status to members, clients, and providers

Resolve problems by identifying the customer's complaint, selecting and explaining the best resolution for the issue; escalate to upper management when necessary

Keep managers informed of any issues that may require their attention to avoid or resolve an existing problem

Apply knowledge, experience, common sense, and critical thinking to all issues being dealt with. Multi-task and prioritize

Respond to general inquiries from members and providers (plan benefits, limits, co-pays, deductibles, policy procedures, reimbursements, etc.). Redirect callers when necessary

Follow up until completion on all issues that are not resolved on the initial contact, and keep parties updated on steps and actions taken

Service the maximum number of callers in the quickest and most efficient way without sacrificing the quality of the service

Job Specifications

Typically has the following skills or abilities:

1+ year of Member Services experience in the Healthcare industry

Proficient with computers

English and Spanish bilingual

Call Center Business Hours: Monday - Friday, 8:00 AM - 7:00 PM EST/5:00 AM - 4:00 PM PST

Preferred Skills

Strong understanding of health plan terminology

#LI-REMOTE

The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here.