Member Service Rep Mercycare Insurance

Member Service Representative

Overview Member Service Rep, MercyCare Insurance Customer Service, Days, 80 hrs / 2 wks Schedule : Monday - Friday 8 : 00am - 4 : 30pm

Responds to all incoming correspondence and telephone inquiries directly related to the position in a professional manner consistent with the health system's mission. Attend seminars / training sessions. They may be required to work overtime during peak periods. Performs other duties as assigned.

Responsibilities 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- Members or someone calling on behalf of members Providers Pharmacy

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 Experience :

High school education preferred

Special Physical Demands :

While performing the duties of this Job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms. Specific vision abilities required by this job include close vision, peripheral vision, and the ability to adjust focus.