Member Services Supervisor supervises a group of member services representatives that address 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 researching more complex questions, investigating the cause of the issue, and responding to members on escalated issues. Being a Member Services Supervisor assists with hiring, training, ongoing monitoring and QA, performance evaluations and any corrective actions of member services representatives. Requires a high school diploma or its equivalent. Additionally, Member Services Supervisor typically reports to a manager. The Member Services Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Thorough knowledge of functional area under supervision. To be a Member Services Supervisor typically requires 3 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)
Description
The Member Services Coordinator reviews and keys manual 125 claim reimbursement submissions. Processes and approves eligibility changes to member database to produce an accurate monthly billing statement. Sends enrollment files to carriers and works with carriers and members to correct error reports and update database by performing the following duties.
Requirements
Required Education: High school diploma or general education degree (GED).
Required Work Experience: Two to five years of related experience and/or training, or equivalent combination of education and experience.
Technology Skills: Proficient with Microsoft Office
Required skills or trats for the position: Ability to organize and prioritize tasks and work assignments; ability to complete multiple tasks simultaneously with accuracy and quality. Excellent written and oral communication skills. Strong analytical and research skills with great attention to detail. Strong math and accounting skills. Solid problem identification and resolution and decision-making skills.
Specialized Training/Certifications: Must be willing to obtain Iowa Accident Health and Life insurance license within the first year of employment.