Member Service Support Specialist
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Job Description
Member service specialist supporting members and providers with benefits, claims, and eligibility inquiries. NationsBenefits provides healthcare fintech and supplemental benefits solutions to managed care organizations.
Responsibilities:
- Answer inbound calls from members and providers regarding health plan benefits, claims, eligibility, and general inquiries
- Research, locate, and provide accurate information while ensuring a positive customer experience
- Resolve member service issues by identifying concerns, researching solutions, implementing appropriate resolutions, and escalating complex issues when necessary
- Review and analyze claims based on diagnosis codes, procedures, provider information, medical policies, contracts, and established policies and procedures
- Educate members and providers on benefits, coverage, and health plan processes
- Identify members who may benefit from care management or managed care interventions and collaborate with clinical staff to facilitate appropriate services
- Document all interactions accurately and thoroughly in accordance with company policies and regulatory requirements
- Maintain compliance with HIPAA and applicable healthcare regulations
- Meet productivity, quality, attendance, and customer satisfaction standards
Requirements:
- High School Diploma or GED required
- Strong computer and data entry skills
- Excellent verbal and written communication skills
- Strong problem-solving and critical-thinking abilities
- Ability to multitask and navigate multiple systems simultaneously
- Attention to detail and commitment to accuracy
- Ability to work independently and as part of a team
- Professional demeanor with a strong focus on customer satisfaction
- Previous call center or customer service experience preferred
- Working knowledge of Medicare and Medicaid programs preferred
- Minimum of one (1) year of customer service or call center experience preferred
- Healthcare, insurance, Medicare, or Medicaid experience preferred
- Knowledge of health plan systems, products, policies, procedures, and departmental functions
- Ability to maintain HIPAA and healthcare regulatory compliance
Benefits:
- Career advancement opportunities from within the organization
- Fulfilling work environment
- Opportunities across multiple locations in the US, South America, and India
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