Company Name:
Beacon Health Options
Approximate Salary:

Location:
CYPRESS, California
Country:
United States
Industry:
Healthcare
Position type:
Unspecified
Experience level:
Education level:

MEMBER SERVICES TEAM LEADER



Location
CA: Cypress

Job Family
Customer Service

Job Brief
The Member Services Team Leader role will provide additional hands on assistance to all Member Services Representatives. This role will bring extensive knowledge of all Beacon related products and protocol related to Beacon/CHIPA claims, Provider Relation

Non-Exempt

Weekdays Only

ABOUT THE POSITION

We are currently seeking a dynamic Member Services Team Leader to join our team at our office in Cypress, California. The Member Services Team Leader role will provide additional hands on assistance to all Member Services Representatives. This role will bring extensive knowledge of all Beacon related products and protocol related to Beacon/CHIPA claims, Provider Relations, and all Member benefit information. In addition, the Member Services Team Leader will also be responsible for monitoring Member Services Staff's breaks, lunches, After Call Work (ACW), and Average Handle Time (AHT). Primary focuses are: ensuring that Member Service Representatives are providing accurate and all relevant info to Members and Providers in a timely fashion as established by the Member Services Department Standards. The Member Services Team Leader will also assist with handling claims tickets for resolution. The Member Services Team Leader will also assist with handling incoming calls during periods of high call volume.

Position Responsibilities:
  1. Answers internal & external calls.
  2. Makes outbound calls to customers or clients about detailed account information.
  3. Conducts outreach calls to members and providers.
  4. Identifies and prevents potential member and provider concerns.
  5. Reports all new and reoccurring issues to management.
  6. Proactively assists Member Service Representatives with questions and escalated calls.
  7. Handles and prioritizes a large workload inventory.
  8. Produces a weekly claims recap that contains updates, changes, issues on claims for Member Services
  9. Documents claims actions by completing forms, reports, logs, and records.
  10. Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
  11. Maintains quality customer service by following customer service practices, responding to customer inquiries.
  12. Stays current with system, product, and service plans and participate in educational opportunities.
  13. Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
  14. Forwards member and provider complaints per health plan guidelines.
  15. Resolves complex claims issues from members and providers
  16. Monitors claims resolution tickets to ensure distribution to the resolution team.
  17. Monitors and replying to chats.
  18. Assists in monitoring Member Services Representatives queues to ensure adequate phone coverage.
  19. Assists with training new employees.
  20. Assists Member Services Supervisors with keeping all related company protocols up to date.
  21. Reviews fax servers/handle Member Service department faxes.
  22. Creates and updates department break & lunch schedules.
  23. Provides HIPAA Release Forms for BMCHP-Family Consent.
  24. Adheres to all Beacon policies and procedures and standards of operations.
  25. Completes all required and assigned trainings.
  26. Attends all mandatory company or department meetings.
  27. Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.Complete full schedule shift on a regular basis.
  28. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  29. Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
  30. Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
  31. Assist team members and offers suggestions to improve processes, culture, or work environment.
  32. Performs special projects and other duties as assigned and required.

Duties and Responsibilities for Member Services Claims Branch
  1. Partners and collaborates with other departments to resolve complex claims issues.
  2. Resolve problems and provides immediate Claims Member Services Representative & Claims Resolution feedback.
  3. Assists Member Services Supervisors with data entry of Claims Member Services Representative audit scores.
  4. Assists Member Services Supervisors in pulling Claims Resolution reporting.
  5. Monitors turn-around times are met and that resolution tickets are completed & closed.

Knowledge, Skills & Abilities:
  • Prior Member or Customer Service experience preferred
  • Able to answer and resolve a high volume of member and provider calls effectively
  • Working knowledge of medical billing codes ICD9 / ICD10 and CPT coding a plus
  • Bilingual: Korean, Farsi, Vietnamese, Cantonese, and/or Spanish language skills a plus

    Education: High School diploma or GED required, Bachelor's degree preferred.

    Years and Type of Relevant Work Experience:
  • 2 years call center and/or customer service experience in resolving billing and claims issues.

TO APPLY

Click below on "Apply for this Position" to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

AAP Reporting Location:

CA - Cypress

ID (Req #):

53173

FTE Status:

Full time

Schedule:





PI100442682