• Member Engagement Representative

    Job Locations US-VA-Chesapeake | US-VA-Glen Allen
    Job ID
    2018-5126
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Member Engagement Representative (MER) is responsible for informing, assisting and educating members on how to properly use the medical services available to them. The MER position is responsible for receiving inbound and making outbound calls to help facilitate resolution of member issues. The MER will handle and document all member inquiries, schedule transportation requests, verify eligibility and make necessary referrals and other related issues in an effort to provide information and facilitate and/or coordinate appropriate resolutions. The MER will build and maintain relationships in order to retain members.

    Responsibilities

    • Respond accurately and courteously to member and provider inquiries regarding benefit interpretation, eligibility, claims status, accessing care through plan providers, and other health plan related issues.
    • Provide information, facilitate and/or coordinate appropriate resolution of member issues.
    • Assist members on how to properly use the medical services available to them.
    • Build and maintain relationships in order to retain members.
    • Verify member eligibility for physician offices, ancillary providers, and hospitals.
    • Document member/provider inquiries, complaints, hospital notification, and other data in CRM in an accurate, clear, and timely manner.
    • Conduct outbound telephone calls consistent with programs promoting health plan education, health and wellness for members.
    • Participate as needed in special projects such as telephone surveys to members and departmental training.
    • Assist management in achieving established department production and quality goals through individual and team efforts.
    • Actively participate in developing and maintaining a cohesive customer service team that is focused on providing excellent customer service.
    • Establish and maintain good working relationships with others in the organization.

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • High school diploma or equivalent required
    • Associates degree preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Excellent customer service, interpersonal skills and telephone etiquette. The ability to work with people with diverse needs in a respectful and courteous manner at all times.
    • Ability to operate a PC in a Microsoft Windows operating system, including Microsoft Office software such as Word and Excel.
    • Strong typing/data entry skills
    • Proven track record working in a professional environment, with knowledge of office protocols, machines and equipment.
    • Good organizational skills: the ability to prioritize, organize, and complete daily work both independently and with team members as well as with or without routine supervision.
    • Ability to research documented calls in Pivotal CSM and QNXT.
    • Ability to exercise good judgment and initiative to determine the appropriate action in non-routine situations.
    • Demonstrated oral communication skills including the ability to convey complex information in a way that is easily understood by the member.
    • Demonstrated written communication skills particularly the ability to summarize notes in a clear, concise manner.
    • Ability to maintain a professional demeanor and confidentiality.
    • Ability to cope well under stressful situations.

    WORK BACKGROUND/EXPERIENCE

    • Minimum three (3) years customer service experience (insurance, managed care, or a provider setting)
    • Minimum one (1) year Member Operations Representative experience
    • Experience in a call center environment strongly desired.
    • Experience with state programs Medicaid/Medicare a plus.

    MANDATORY REQUIREMENTS

    • Be available to work any shift between 8am – 8pm, Monday thru Sunday during the Annual Enrollment Period of October 15th thru March 31st.
    • Be available to work any shift between 8am – 8pm, Monday through Friday from April 1st thru September 30th.

     

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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