Member Services Representative

Location: Louisville, KY 40223 Status: Full Time, Employee Job Category: Medical/Health Relevant Work Experience: 2+ to 5 Years send this job to a friend Job Description JOB DESCRIPTION  For HR Use Only:Job Title: Member Services Representatives   Job Code:MSR Job Title this Position Reports to: Team Lead  Exempt/Non-Exempt:Non-ExemptDepartment/Business Group:  Member Services  Other:    I. OVERVIEW/GENERAL PURPOSE OF POSITION Member Services Representative …. Receive inbound calls from beneficiaries enrolled into the Part D program.  Assist beneficiaries with updating account information, providing plan information, and resolving issues with utilization of the plan.   II.  ESSENTIAL DUTIES AND RESPONSIBILITIES Update account information such as billing options and changes of address or phone numbers.  Research premium billing discrepancies and prescription claims processed.   Educate beneficiaries on how the Part D plan works, including benefits, cost sharing, and levels of coverage.  Submit mail requests for beneficiaries such as ID cards and formularies. Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered provide an explanation as to why. Make concise and detailed notations as it pertains to member records. Assist pharmacies with prescription denials and errors and verifying benefits. Advise providers on how to get prior authorizations on medicines prescribed with restrictions such as step therapy and quantity limits.  Answer questions pertaining to mailings sent out by the company periodically. Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner. Enrollment/Member Services Representative – page 2 Conform with and abide by all regulations, policies, work procedures and instructions. Respond promptly when returning telephone calls and replying to correspondence and faxes. Act, dress, and behave in a professional manner to reflect a positive image of the company.     III. OTHER DUTIES AND RESPONSIBILITIES 1. Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company.2. Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by Company.3. Responsible for performing other duties and responsibilities as required.    IV.  REPORTING RELATIONSHIP _X_  This position has no supervisory responsibilities____  Provides work direction only____  Provides work direction plus has responsibility for hiring, promotions, transfers, performance management, discipline and discharge, etc. Positions supervised (identify positions reporting directly to this position) Title:_________________________ Apprx. Number in Position: ________Title:_________________________ Apprx. Number in Position: ________Title:_________________________ Apprx. Number in Position: ________Title:_________________________ Apprx. Number in Position: ________             IV.  JOB REQUIREMENTS Education and Experience – Required education, training, licenses, accreditation or certification and number of years and type of directly related experience.  If applicable, please identify if an alternate “equivalencyâ€� of a combination of education and experience is sufficient. Degree _HS Diploma_______________________ Preferred major/area of study ______________________ Number of years of supervisory/management experience (if any) ____________________ Number of years of experience ________  Type of experience – Requires …… High school diploma or equivalent.  Some previous customer service experience is preferred or any equivalent combination of related training and experience.   Knowledge, Skills, and Abilities: Ability to provide clear and accurate information and follow up when necessary Strong attention to detail. Ability to solve problems - identifies and resolves problems in a timely manner, gather and analyze information skillfully, develop alternative solutions, work well in group problem solving situations, and use reason even when dealing with emotional topics. Requires technical skills - Assess own strengths and weaknesses, pursue training and development opportunities, strive to continuously build knowledge and skills, and share expertise with others. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.   Ability to write routine reports and correspondence.   Ability to speak effectively before groups of customers or employees of organization. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.   Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.   Ability to deal with problems involving several concrete variables in standardized situations. Skill in dealing politely, tactfully and firmly with a wide range of people and personalities. Skill in communication and interpersonal skills sufficient to exchange or convey information and to receive work direction.  Skill in organizing and prioritizing tasks.   Enrollment/Member Services Representative – page 3 Knowledge of business English grammar, spelling and composition.   Knowledge of business etiquette. Must be able to operate computer, calculator, copier, fax machine, phone and other office equipment. Must be able to multi-task and think quickly.   Ability to communicate well orally and in writing in the English language. Ability to analyze data and prepare reports. Ability to understand and carry out complex oral and written instructions. Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others. Ability to work in an environment with many interruptions. Ability to be flexible and juggle many assignments or projects at the same time. Working efficiently in a stressful environment. Computer Equipment and Software Requirements:   This position requires the ability to work with a personal computer in a Windows environment.  Must be proficient in Word, Excel, ARGUS, NationsHealth, and CignatureRx.com.                       V. WORK ENVIRONMENT 1. Tasks involve the ability to …[please insert].  2. Most tasks are performed in a standard office environment; however, when not in the office environment, tasks may be regularly performed with exposure to adverse environmental conditions, such as dirt, dust, pollen, odors, wetness, humidity, rain, snow, fumes, heights, temperature extremes, noise extremes, machinery, vibrations, electric currents, traffic hazards, explosive hazards, toxic agents, radiation, disease, pathogenic substances, vermin or insect infestation, violence, gang or criminal activity. 3. The normal work routine involves no exposure to blood, body fluids, or tissues (although any work environment presents some small risk of exposure to body fluids).  Individuals who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid.  The normal work routine may involve tasks that involve handling implements or utensils, the use of public or shared bathroom facilities or telephone and personal contacts such as handshaking. VI.  DISCLAIMER This job description is intended to describe the typical duties and responsibilities associated with the identified job.  It does not include all duties and responsibilities of the position.  The Board of Directors or Company officers may assign additional duties that are not listed in this job description.  The order in which duties and responsibilities are listed does not necessarily reflect their relative importance. Contact Information Company: NationsHealth Click here to see all "NationsHealth, Inc." opportunities send this job to a friend