Call Center Representative - Member Services

 Job Description: The Rep Member Service I is proficient in routine benefits claims and general inquiries. They have a general knowledge of the following: systems benefits contracts/products functions of other departments in the company standard operating procedures claims status enrollment/billing and follow-up to a customer inquiry. Answers member inquiries by clarifying desired information researching locating and providing information. Resolves member service problems by clarifying issues researching and exploring answers and alternative solutions implementing solutions escalating unresolved problems. Examines claims to identify key elements and processing requirements based on diagnosis procedures provider medical policy contracts and policy and procedures. Calculates deductibles maximums and determining resolving reporting and following through on overpayments underpayments and managed care processes. Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines generating accurate billing for policies and products purchased by new clients existing clients and transfers from other BCBS Plans. Learns the details of offering and administering various billing transactions i.e. direct pay credit card payment and debit accounting through the policyholders checking account and how to effectively interact with or advise clients group administrators brokers or providers on problem resolution. Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention. Qualifications High School Diploma or GED Experience performing duties that are detailed in nature exposure to health care health insurance medical information and direct service experience is preferred. 1-3 years of recent healthcare customer service representative experience About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.