Member Service Representative Mercycare

MERCY HEALTH CORPORATION • Janesville, WI • 1d ago

JOB REQUIREMENTS: OVERVIEW Support health insurance members by answering
questions, resolving complex issues, and helping patients understand
their benefits, coverage, pharmacy needs, and authorization requests.
This role serves as a knowledgeable resource for members and team
partners while delivering excellent customer service, problem-solving
support, and timely follow-up in a fast-paced call center environment.
Schedule: 40-hours per week Shift: Days Location: MercyCare Building,
Janesville, WI Pay Range: \$18.65 - \$29.84 ESSENTIAL DUTIES AND
RESPONSIBILITIES Serve as a resource or Subject Matter Expert (SME) for
other team members or internal members in the following areas: WI and
Illinois Group EPO, HMO, PPO, POS lines of business WI and Illinois
Individual Marketplace WI Medicaid WI Medicare Supplemental Insurance WI
and Illinois Pharmacy Riders Handle escalated calls, resolving more
complex member issues in a one-and-done manner Answer incoming phone
calls from members and identify the @type of assistance the member needs
Ask appropriate questions and listen actively to identify specific
questions or issues while documenting required information in computer
systems Assist members in navigating Mercyhealth\'s websites and
encourage and reassure them to become self-sufficient Assist members in
choosing a primary care physician and scheduling their first appointment
or when assistance getting an appointment is asked for by the member Own
problem through to resolution on behalf of the member in real-time or
through comprehensive and timely follow-up with the member Research
complex issues across multiple databases and work with support resources
to resolve member issues and/or partner with others to resolve escalated
issues Provide education and status on previously submitted
pre-authorizations or pre-determination requests Responsible for
entering all approved authorizations into the pharmacy benefit
management system. Also responsible for entering overrides to ensure
members receive their prescriptions promptly. Assist in taking premium
payments from members for our marketplace line of business. Meet the
performance goals established for the position in the areas of
first-call resolution, service level, occupancy rate, percentage of
calls held, redirect, attendance, NCQA required audits, and any
contractual requirements (ETF, Medicaid, etc.) EDUCATION AND/OR
EXPERIENCE High school educationpreferred PAY RANGE: \$18.65 - \$29.84
Mercyhealth is an Equal Opportunity Employer. All qualified applicants
will receive consideration for employment without regard to race, color,
religion, sex, sexual orientation, gender identify, national origin,
disability, or protected veteran status. Mercyhealth offers competitive
pay and a comprehensive... For full info follow application link.
EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity
employer functioning under Affirmative Action Plans. ***
APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/711B507C26C64011

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