Member Service Representative

JOB REQUIREMENTS: Overview Responds to all incoming correspondence andtelephone inquiries directly related to the position in a professionalmanner consistent with the health system\'s mission. Attendseminars/training sessions. They may be required to work overtime duringpeak periods. Performs other duties as assigned. ResponsibilitiesEssential Duties and Responsibilities Serve as a resource or SubjectMatter Expert (SME) for other team members or internal members in thefollowing areas: WI and Illinois Group EPO, HMO, PPO, POS lines ofbusiness WI and Illinois Individual Marketplace WI Medicaid WI MedicareSupplemental Insurance WI and Illinois Pharmacy Riders Handle escalatedcalls, resolving more complex member issues in a one-and-done mannerAnswer incoming phone calls from members and identify the type ofassistance the member needs- Members or someone calling on behalf ofmembers Providers Pharmacy Ask appropriate questions and listen activelyto identify specific questions or issues while documenting requiredinformation in computer systems Assist members in navigatingMercyhealth\'s websites and encourage and reassure them to becomeself-sufficient Assist members in choosing a primary care physician andscheduling their first appointment or when assistance getting anappointment is asked for by the member Own problem through to resolutionon behalf of the member in real-time or through comprehensive and timelyfollow-up with the member Research complex issues across multipledatabases and work with support resources to resolve member issuesand/or partner with others to resolve escalated issues Provide educationand status on previously submitted pre-authorizations orpre-determination requests Responsible for entering all approvedauthorizations into the pharmacy benefit management system. Alsoresponsible for entering overrides to ensure members receive theirprescriptions promptly. Assist in taking premium payments from membersfor our marketplace line of business. Meet the performance goalsestablished for the position in the areas of first-call resolution,service level, occupancy rate, percentage of calls held, redirect,attendance, NCQA required audits, and any contractual requirements (ETF,Medicaid, etc.) Education and Experience High school education BenefitsMercyhealth offers a generous total rewards package to eligibleemployees including, but not limited to: Comprehensive Benefits Package:Mercyhealth offers a retirement plan with competitive matchingcontribution, comprehensive medical, dental, and vision insuranceoptions, life and disability coverage, access to flexible spendingplans, and a variety of other discounted voluntary benefit options. \*Competitive Compensation: Mercyhealth offers market competitive rates ofpay and\... For full info follow application link.EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunityemployer functioning under Affirmative Action Plans. \*\*\*\*\*APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/3B94AE8C21454416