Anthem, Inc. MEMBER SERVICES REPRESENTATIVE in Wixom, Michigan
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Member Service Representative (Must live within a commutable distance to Wixom)
Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the expectation that you will return to a regular, in-office work environment. As we continue to monitor guidance from CDC and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities
Job Title: Member Service Representative (Must live within a commutable distance to Wixom) Exemption Status: Non Exempt Reports to: Manager, Member Services Job Code: ST918 Salary Grade: Union – Grade 4
General Summary: Answer subscriber and provider questions about benefits, eligibility, claims and certification. Ensure customer satisfaction and promote a positive corporate public image. Screen incoming subscriber and provider calls/inquiries and take data to initiate cases. Quote accurate benefit and policy information regarding inpatient and alternative levels of care. Handle complicated inquires and educate providers/subscribers in the certification process and reconcile inconsistencies and procedural difficulties when necessary Perform all data entry for case initiation and update and enter data into system for non-participating providers. Special projects and all other duties as assigned.
Duties and Responsibilities 1. Perform responsibilities and tasks in ways that promote good will, build positive relationships, preserve human dignity and contribute positively to the corporation service orientation. Service calls in a professional and courteous manner. Perform review of service requests for completeness of information.
Answer telephone calls identifying those needing case management services, those needing referral to routine outpatient services, and those needing authorization and/or verification. Answer questions from providers, members, insurance carriers and/or Beacon regional offices. Certify benefits per account specific guidelines. Provide list of in-network providers to callers. Explain benefits and benefit maximums that have been reached. Verifies benefits against contract requirements prior to case initiation. Refers complicated cases to Case Managers. Collect and transfer non-clinical data. Acquire structured clinical data. Perform activities that do not require evaluation or interpretation of clinical data.
Attend all staff meetings, team conferences and in-service as directed. Comply with all credentialing and other PSO requirements. Assist to train new unit personal and to set up new clinical case management units as directed. Assist in special projects as directed by the Department Manager/Supervisor. Assist clinical area managers to prepare for re-authorization of services by gathering necessary information and retrieving relevant subscriber files. Assist to maintain subscribers’ files. Assist Clinical Case Managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility and researching provider information.
Record complaints, grievances and appeals.
Collects demographic data from providers/subscribers for case initiation. Completes data entry for authorizations. Perform data entry for case initiation and updates. Research and investigate claims inquiries. Document all inquiries.6. Apply Beacon policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations, accuracy, productivity, and performance standards. Support Beacon in achieving Mission Statement. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment. Complete tasks accurately and within required timeframes.
Bachelors’ degree in Social Work, Psychology or equivalent in a related health care field.
A minimum of one year of customer service experience or experience in the behavioral health care field.
Strong customer service orientation, and excellent written and verbal communication skills especially telephone service skills required. All applicants will be required to demonstrate their customer service skills by participating in a test phone call simulation.
- Must demonstrate ability to quickly summarize telephone conversations and accurately input to a computer. Must demonstrate ability to maintain a professional demeanor during a crisis situation. Excellent time management and organizational skills needed.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.