Member Services Representative, Sr. jobs in North Las Vegas, NV

Member Services Representative, Sr. addresses more complex health plan or HMO member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls and written requests. Being a Member Services Representative, Sr. provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative, Sr. requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)

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Member & Provider Services Representative
  • Tristar Insurance
  • Las Vegas, NV OTHER
  • Job Details

    Level:    Entry
    Job Location:    Las Vegas Office - Las Vegas, NV
    Position Type:    Full Time
    Education Level:    High School Diploma or GED
    Salary Range:    $18.00 - $20.00 Hourly
    Travel Percentage:    None
    Job Shift:    Day
    Job Category:    Admin - Clerical

    Member & Provider Services Representative

    JOB LOCATION:  

    Las Vegas, Nevada (office-based), Hybrid, or Remote.

    Bilingual English/Spanish required for this position

    This position will be office-based during the required training, as applicable. Once training is complete, the position will become hybrid or remote-based subject to company remote-work policies. Working permanently on a hybrid or remote schedule is not a guarantee for this position.

    POSITION SUMMARY:  Under general supervision, this position is responsible for creating a positive plan participant and provider experience by providing a superior level of customer service. The Member and Provider Services Representative supports, develops and maintains service relationships with all client members and providers.

     

    DUTIES AND RESPONSIBILITIES:

    • Effectively communicate and explain all plan benefits.
    • Answer incoming calls from providers that have inquiries about eligibility and benefits, claims or authorizations plan participants.
    • Assist with the review of plan benefit summaries, medical coverage and exclusions to ensure plan participants and providers are accurately informed.
    • Accurately document all conversations in the system to ensure all communication with plan participants and providers are archived for future reference, as needed.
    • Effectively access and manage resources available in the claims systems.
    • Coordinate with other departments to ensure provider and plan participant claim issues are timely resolved as applicable.
    • Ensure supervisor is kept abreast of plan participant or provider issues and escalate concerns to supervisor for guidance or handling as applicable.
    • Manage and timely respond to all plan participant and provider calls in a professional manner throughout the duration of the conversation.
    • Immediately report to supervisor any system or equipment issues, downtimes, or when access to remote office provided resources is unavailable, to ensure supervisor initiates appropriate action and directives.
    • Ensure that communication tools such as instant messaging (jabber); email, Zoom, or other available sources of communication are frequently used to stay in touch with the team, supervisors and others within the organization.
    • Regular attendance in accordance with hours of operations are essential functions of the job.
    • Other duties as assigned

     

    EQUIPMENT OPERATED/USED:  Computer, 10-key, printer, copier, fax machine and other office equipment.

    SPECIAL EQUIPMENT OR CLOTHING:  Appropriate office attire required when conducting business with internal/external personnel remotely or in person

    Qualifications


    QUALIFICATIONS REQUIRED:

    Education and/or Experience:

    • High school diploma or GED required and the following:
    • Minimum one year customer service experience; preferably in the medical or employee benefit administration industry.

     

    Other Qualifications:

    • Bilingual (Spanish and English)

     

    Knowledge, Skills and Abilities:        

    • Knowledge of multi-line telephone
    • Excellent organizational and multi-tasking skills
    • Intermediate computer skills
    • Advanced written communication skills (typing (55 wpm), grammar, spelling, correspondence drafting, etc.)
    • Knowledge of office equipment (fax, copier, etc.)
    • Highly detail oriented, excellent problem solving skills, ability to consistently meet minimum production standards, and positive attitude towards staff and customers
    • Ability to adapt to change
    • Excellent communication skills both verbal and written
    • Ability to work independently as well as being a team player
    • Must be knowledgeable in all aspects of member plans and benefits
    • Demonstrated understanding of confidentiality as it may relate to participants and  co-workers
     

     

    Here are some of the benefits you can enjoy in this role;

    • Medical, Dental, Vision, Life Insurance, Disability
    • 401(k) plan
    • Paid time off.
    • Paid holiday.

     

    Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]

     

     

     

     
     
     
     

                                  MENTAL AND PHYSICAL REQUIREMENTS

     

    1.  MENTAL EFFORT

     

    a.       Reasoning development:

     

               Follow one- or two-step instructions; routine, repetitive task.

     

             Carry out detail but uninvolved written or verbal instructions; deal with a few concrete                            variables.

     

             Follow written, verbal, or diagrammatic instructions; several concrete variables.

     

     X      Solve practical problems; variety of variables with limited standardization; interpret instructions.

     

             Logical or scientific thinking to solve problems; several abstract and concrete variables.

     

             Wide range of intellectual and practical problems; comprehend most obscure concepts.

     

    b.       Mathematical development:

     

              Simple additional and subtraction; copying figures, counting, and recording.

     

              Add, subtract, multiply, and divide whole numbers.

     

     X      Arithmetic calculations involving fractions, decimals, and percentages.

     

              Arithmetic, algebraic, and geometric calculations.

     

              Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

     

              Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

     

    c.       Language development:

     

              Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

     

              Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

     

              Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

     

     X      Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

     

              Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

     

    2.  PHYSICAL EFFORT

     

    a.       Physical activity required to perform the job:

     

              Sedentary work:  Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.  Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

     

     X      Light work:

    a.    Exerting up to 20 pounds of force occasionally

    b.    Exerting up to 10 pounds frequently

    c.    Exerting a negligible amount of force constantly to move objects

     

              (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

     

              Medium work:

    a.    Exerting up to 50 pounds of force occasionally

    b.    Exerting up to 20 pounds of force frequently

    c.    Exerting up to 10 pounds of force constantly to move objects

     

              Heavy work:

    a.    Exerting up to 100 pounds of force occasionally

    b.    Exerting up to 50 pounds of force frequently

    c.    Exerting up to 20 pounds of force constantly to move objects

     

              Very heavy work:

    a.    Exerting in excess of 100 pounds of force occasionally

    b.    Exerting in excess of 50 pounds of force constantly to move objects

    c.    Exerting in excess of 20 pounds of force constantly to move objects

     

        

     

    1. Visual requirements necessary to perform the job:

     

             Far vision:  clarity of vision at 20 feet or more

     

     X      Near vision:  clarity of vision at 20 inches or less

     

     X      Mid-range vision:  clarity of vision at distances of more than 20 inches and less than 20 feet

     

             Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are

     

             Color vision:  ability to identify and distinguish colors

     

             Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point

     

    2.  PHYSICAL EFFORT (cont.)

        FREQUENCY

     

    c.    Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

     

            Climbing:      Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms.  Body agility is emphasized.  This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

     

            Balancing:     Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces.  This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

     

     X    Stooping:       Bending body downward and forward by bending spine at the waist.  This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

     

     X    Kneeling:       Bending legs at knee to come to a rest on knee or knees.

     

     X    Crouching:    Bending the body downward and forward by bending legs and spine.

     

           Crawling:      Moving about on hands and knees or hands and feet.

     

     X    Reaching:      Extending hand(s) and arm(s) in any direction.

     

     X    Standing:       Particularly for sustained periods of time.

     

     X    Walking:       Moving about on foot to accomplish tasks, particularly for long distances.

     

     X    Pushing:        Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.

     

     X    Pulling:         Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.

     

            Foot

           Motion:          Using feet to push pedals.

     

     X    Lifting:          Raising objects from a lower to a higher position or moving objects horizontally from position to position.  This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

     

     X    Fingering:     Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

     

     X    Grasping:      Applying pressure to an object with the fingers and palm.

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Occasionally

     

     

     

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    Frequently

     

     

     

     

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    2.  PHYSICAL EFFORT (cont.)                  

          FREQUENCY

     X    Talking:         Expressing or exchanging ideas by means of the spoken word.  Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

     

     X    Hearing:        Perceiving the nature of sounds with or without correction.  Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.

     

           Feeling:         Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

     

     X    Repetitive      Substantial movements (motions) of the wrists, hands,

           Motion:         and/or fingers.

    Frequently

     

     

     

    Frequently

     

     

     

     

     

     

     

    Frequently

     

     

    3.  WORKING CONDITIONS

     

    Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. 

     

           WORKING CONDITION

               ENVIRONMENTAL

                         FACTOR

               NATURE/REASON

                   OF EXPOSURE

     

                    FREQUENCY

    Dirt/Dust

     

     

    Noise

     

     

    Temperature extremes

     

     

    Dampness

     

     

    Vibrations

     

     

    Equipment movement hazard

     

     

    Chemicals/solvents

     

     

    Electrical shock

     

     

    Significant work pace/pressure

     

     

    Odors/Fumes

     

     

    Other (specify):                              

     

                                                             

     

     

  • 10 Days Ago

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Member Services Representative I
  • LA Financial Credit Union
  • Lake, AZ FULL_TIME
  • Member Service Representative I (MSR I) Reports To: Branch Manager Directly Supervises: None Exemption Status: Non-Exempt Location: Lake Havasu, AZ - onsite Position Status: Onsite Why should you work...
  • 12 Days Ago

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Member Services Representative
  • Planet Fitness - Garlan
  • Henderson, NV PART_TIME
  • Job Summary The Member Services Representative will be responsible for creating a positive member experience by providing a superior level of customer service to Planet Fitness members, prospective me...
  • 21 Days Ago

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Member Services Representative
  • Planet Fitness - Garlan
  • Las Vegas, NV PART_TIME
  • Job SummaryThe Member Services Representative will be responsible for creating a positive member experience by providing a superior level of customer service to Planet Fitness members, prospective mem...
  • 22 Days Ago

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Member Services Representative (LV Sunset)
  • Planet Fitness LV-Sunset (Henderson)
  • Henderson, NV FULL_TIME
  • At Planet Fitness, we pride ourselves in creating a culture that empowers people to live a healthy lifestyle. Our goal is to assist our members and our employees to reach their full potential.We are c...
  • 4 Days Ago

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Member Services Representative Part Time
  • Planet Fitness - Garlan
  • Las Vegas, NV PART_TIME
  • Job Summary The Member Services Representative will be responsible for creating a positive member experience by providing a superior level of customer service to Planet Fitness members, prospective me...
  • 2 Months Ago

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0 Member Services Representative, Sr. jobs found in North Las Vegas, NV area

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Member Service Representative I (FT) - Westcliff
  • Silver State Schools Credit Union
  • Las Vegas, NV
  • Member Service Representative I Full-Time (40 Hours) Monday- Saturday (Varies) Westcliff 170 South Rainbow Blvd Las Vega...
  • 4/18/2024 12:00:00 AM

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Head of Travel Reservations Operations
  • Ten Lifestyle Group
  • Las Vegas, NV
  • The role will be to manage the operational day-to-day running of our local teams in conjunction with our regional office...
  • 4/18/2024 12:00:00 AM

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Member Service Representative
  • Guadalupe Credit Union Inc.
  • Las Vegas, NV
  • ** Guadalupe Credit Union** ** Member Service Representative** Las Vegas, NM 87701 Were looking for a **Member Service R...
  • 4/17/2024 12:00:00 AM

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Bilingual Customer Service Rep (Work From Home)
  • Endicott Call Centers
  • North Las Vegas, NV
  • ** Bilingual Customer Service Rep (Work From Home)** **Job Category****:** Operations **Requisition Number****:** CUSTO0...
  • 4/17/2024 12:00:00 AM

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Call Center Customer Service Agent
  • EnergyCare
  • Las Vegas, NV
  • ?EnergyCare is a premier provider of customer services for energy and healthcare industry clients. We are currently look...
  • 4/17/2024 12:00:00 AM

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Steward, Kassi Beach Club - Pool
  • Virgin Hotels
  • Las Vegas, NV
  • Job Description YOUR MISSION (The Job Description) The Steward position reports to Kassi Beach Club Executive Chef and i...
  • 4/17/2024 12:00:00 AM

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Front Desk/Member Services Representative Part Time
  • Planet Fitness Inc.
  • Las Vegas, NV
  • Job Summary The Member Services Representative will be responsible for creating a positive member experience by providin...
  • 4/14/2024 12:00:00 AM

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Customer Advocate
  • Community Choice Financial Family of Brands
  • North Las Vegas, NV
  • Overview: As a Customer Service Representative, you will play an essential part in ensuring that our loyal and new custo...
  • 3/27/2024 12:00:00 AM

North Las Vegas is a city in Clark County, Nevada, United States, in the Las Vegas Valley. As of the 2010 census it had a population of 216,961, with an estimated population of 249,180 in 2017. The city was incorporated on May 16, 1946. It is in the Las Vegas–Paradise, NV MSA and is the fourth largest city in the state of Nevada. Located in the southwestern United States in the Mojave Desert, North Las Vegas sits north and east of Las Vegas. According to the United States Census Bureau, North Las Vegas has a total area of 101.4 square miles (262.6 km2), of which 0.04 square miles (0.1 km2), o...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Member Services Representative, Sr. jobs
$48,014 to $60,075
North Las Vegas, Nevada area prices
were up 2.5% from a year ago

Member Services Representative, Sr. in Memphis, TN
The Member Service Representative (MSR) provides a high standard of financial service to existing and potential members, processing transactions and building relationships while promoting the products and services of the credit union.
December 24, 2019
Member Services Representative, Sr. in Manchester, NH
Customer Service Representatives interface with customers via inbound calls and/or the Internet for the purpose of resolving routine problems with products or services, specifically insurance plans.
February 13, 2020
Delivers best service possible to members when they have requests or queries, always looking for ways to improve our service to them.
January 15, 2020
Member Services Representative, Sr. in Killeen, TX
Provides such member services as opening new accounts, ordering checks, ATM maintenance, corrections, etc.
February 23, 2020