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)
About Us
Abacus Health Solutions is an innovative health management company with a strong history in the development and management of chronic condition programs. Utilizing the latest in healthcare technologies, Abacus translates evidence-based medicine into real world interventions. Our programs for diabetes and hypertension are built to foster high rates of adoption, resulting in healthier, more productive employees.
Abacus values diversity and is committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. This results in greater innovation and collaboration, leading to better solutions. As such, we seek to recruit, develop, and retain the most talented people from a diverse candidate pool. Abacus offers a competitive benefits package and a hybrid work schedule allowing work from home and in-office work.
Company Background
From its inception in 1988 and at its core, Abacus Health Solutions has been a research and development firm. Today Abacus translates evidence-based medicine to real world interventions for our clients and their employees.
A strong behavioral science background shapes the development of all our solutions. Abacus uses these strengths and an experienced team of healthcare experts, technologists, and clinicians to develop and deploy innovative health behavior change tools and targeted programs to help employers control rising healthcare costs and provide high quality health benefits that optimize the health and productivity of their workforce. Abacus works with every client to develop a program that fits the needs and goals of each unique organization. We are excited and passionate about the work we do and the success of our programs has enabled our recent growth.
Job Description
We are an innovative Rhode Island based health management company with customers throughout the U.S. seeking a full-time Member Services Outreach Representative to provide support and encouragement to participants in our health management programs.
Our company continues to grow, provides a professional and supportive, friendly environment, and the successful and motivated candidate will have opportunities for career growth.
Primary Job Function
Responsibilities
Required Skills
Job Requirements
Our benefits package includes:
Job Type: Full-time
Pay: From $42,000.00 per hour
Benefits:
Schedule:
Work Location: Hybrid remote in Cranston, RI