Member Service Representative II

Member Service Representative (MSR) II

The Member Service Representative (MSR) II is commonly the initial contact point for members, providers, and others who contact Western Health Advantage. The MSR II is responsible for answering incoming contacts and assisting them in resolving issues and / or questions they may have. This may involve interaction with other internal departments or external entities such as Medical Groups, Health Care Providers, and / or Brokers. In addition, the MSR II is responsible for resolving issues and / or concerns regarding health plan benefits, policies, procedures, and assists the Senior MSRs when needed.

Representative Duties :

• Respond to all member inquiries related to Commercial, Exchange, and / or Individual plans via telephone, email, chat, or fax.
• Support other Member Service Representatives by answering questions / clarifications regarding plan rules / policies, benefits, and / or system information.
• Research and resolution of cases that require additional investigation; including, when necessary, cases that involve urgent access to care or involve the Member Relations Unit.
• Provide training and call shadowing of new MSRs.
• Accurately record and refer appeals and grievances according to department protocols and procedures.
• Educate members on the Advantage Referral Program, Western Health Advantage's website, and the self-service tools available to them online.
• Assist members, providers, brokers, and plan partners with claims-related billing questions and issues as needed.
• Work with inter and intra-department staff to help resolve member issues to ensure resolution within prescribed timeframes.
• Meet department standards related to performance and attendance.
• Manage difficult or emotional customer situations, responds promptly to customer needs, solicit customer feedback to improve service, respond to requests for service and assistance, and meet commitments.
• Report any system problems or call drivers needing immediate attention to Member Service Supervisor or Manager immediately.
• Use tact, discretion, and courtesy while interacting with clients, the public, and other encounters in the course of work.
• Perform other duties and special projects as assigned.

Qualifications :

Salary :

$22.00 to $25.00 Hourly

Western Health Advantage is committed to providing equal employment opportunities to employees and applicants for employment on the basis of merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis made unlawful by federal or state law.

Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization. Collaborating with the best and the brightest means a dynamic, fulfilling work experience for you and excellent customer service for our members.