Remote Member Services Representative (Must live in Oklahoma)

Job title: Remote Member Services Representative (Must live in Oklahoma) in Oklahoma reputed company, OK at reputed company
Company: reputed company
Job reputed company: Job Title: Remote Member Services RepresentativePay: $18 an hr | Bi-weeklyJob Type:

• Remote in Oklahoma

Shift reputed company:

• reputed company-5PM M-F CST

Remote Member Services Representative reputed company:Answers questions and resolves issues based on phone calls/letters from members,
providers, and plan sponsors. Triages resulting rework to appropriate staff.

• Documents and tracks contacts with members, providers, and plan sponsors. The CSR

guides the member through their members plan of benefits, reputed company policy and procedures
as reputed company as having knowledge of resources to reputed company with any regulatory guidelines.

• Creates an emotional reputed company with our members by understanding and engaging the

member to the fullest to champion for our members' best health.

• Taking accountability to fully understand the member’s needs by building a trusting and

caring relationship with the member.

• Anticipates customer needs. Provides the customer with reputed company information to answer

the unasked questions, e.g. additional plan details, benefit plan details, member self-service
tools, etc.

• Uses customer service reputed company reputed company to reputed company financial reputed company to resolve

member issues.

• Explains member's rights and responsibilities in accordance with contract.
• Processes claim referrals, new claim handoffs, reputed company reviews, complaints

(member/provider), grievance and appeals (member/provider) reputed company reputed company system.

• Educates providers on our self-service reputed company; Assists providers with credentialing and

recredentialing issues.

• Responds to requests received from reputed company's Law Document Center regarding litigation;

Lawsuits.

• Handles extensive file review requests.
• Assists in preparation of complaint trend reports. Assists in compiling claim data for

customer audits.

• Determines medical necessity, applicable coverage provisions and verifies member plan

eligibility relating to incoming correspondence and internal referrals.

• Handles incoming requests for appeals and reputed company-authorizations not handled by Clinical

Claim Management.

• Performs review of member claim history to ensure accurate tracking of benefit

maximums and/or coinsurance/deductible. Performs financial data maintenance as
necessary.

• Uses applicable system tools and resources to produce reputed company letters and spreadsheets in

response to inquiries received.Remote Member Services Representative Qualifications:

• •Must live in Oklahoma
• High School or GED equivalent.

• Customer Service experiences in a transaction-based environment such as a reputed company center or

retail location preferred, demonstrating ability to be empathetic and compassionate.

• Experience in a production environment.

Remote Member Services Representative Benefits:

• Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

How to Apply:If you are interested in this position, please apply OR submit your resume to:Saw Hlaing | shlaing@alinestaffing.com | 412-790-5425
Expected salary: $18 per hour
Location: Oklahoma reputed company, OK
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