Member and Provider Services Representative

Position Purpose
The Member and Provider Service Representative provides exceptional customer service and accurate information to Cooperative members and providers.
Essential Position Functions
+ Answer telephone calls in a pleasant, professional, and efficient manner assuring exceptional customer service.
+ Answer member and provider questions in an accurate and efficient manner incorporating the ?Probing Questions? method. Representatives will also educate our members to the telehealth services Group Health has to offer.
+ Document all incoming calls and outbound calls in the McKesson system in a complete and accurate manner utilizing the ?Probing Questions? format.
+ Follow up on issues resulting from phone calls or reminders as efficiently and accurately as possible.
+ Research member and provider questions as needed using all the appropriate resources available.
+ Conduct outgoing telephone calls for the collection of necessary member information.
+ Assist members who come to the Administrative Office in person with questions or inquiries regarding their policy and benefits.
+ Educate members on plan policies and procedures at every opportunity.
+ Keep up to date on the various plans and benefit structure under each plan.
+ Comply with all company policies and procedures.
+ High school graduate or equivalent. Technical college degree in a related field is preferred.
+ One to three years of customer service experience, call center background preferred.
+ Excellent communication and customer service skills.
+ Proficient in the use of Microsoft Word and Excel.
+ Prior experience in the insurance industry preferred.
+ Knowledge of Medicare, Medicaid, CPT / ICD-9 and ICD 10 medical billing codes, and medical terminology are beneficial.
This position offers an outstanding benefit package, including three weeks of PTO the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com today! Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.

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