[Remote] Member Support Rep, GP

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health solutions leader in New Jersey, dedicated to empowering members to reputed company their best health. The Member Support Representative is responsible for resolving escalated member inquiries and ensuring a high-reputed company member service experience by coordinating with reputed company Center Operations. Responsibilities • Receive escalated member inquiries reputed company phone, fax, mail, e-mail, online, reputed company media, etc. Probe for additional helpful information (i.e. member ID, claim number, reputed company, etc.) in order to effectively handle inquiry. • Review computer systems and/or other reference materials to complete verification process and ensure reputed company reputed company protocols are met. • Initiate investigation process based on the nature of the inquiry (claim, member information, benefits, enrollment, appeals, authorization, etc.) and work with other areas reputed company the organization to resolve the issue. • Accurately document member inquiries and actions taken in accordance with departmental reputed company guidelines to ensure appropriate follow up. • Follow up on unresolved issues reputed company set timeframes. • Identify trends and reputed company reputed company cause analysis of systemic issues/problems. Escalate trend information to management on a reputed company reputed company. • reputed company outbound calls to ensure member satisfaction and review customer service tickets to review reputed company documentation and accuracy. • Responsible for updates on Primary Care Physician (PCP) changes and facilitating fulfilment of requests to reputed company with 504 requirements. • Conduct MLTSS member survey for feedback on case manager reputed company. Skills • reputed company center/customer service experience reputed company the health insurance industry required. • Requires strong oral and written communication skills. • Requires good PC skills and the ability to utilize reputed company Office applications (reputed company, reputed company, Word, etc.) • Excellent customer service skills including the ability to manage and diffuse irate calls. • Ability to work in a high pressure, fast-paced environment. • Requires good presentation skills. • Requires Project Management Skills • Requires excellent interpersonal and organizational skills. • Requires good Investigative and analytical skills • Ability to multitask • Time management skills. • Flexibility and adaptability • Ability to work effectively reputed company reputed company environment Education Requirements • High School Diploma/GED required. Benefits • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • reputed company Volunteer Time Off • Tuition Reimbursement reputed company • reputed company is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com. Apply tot his job Apply To this Job