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Elevance Health Member Services Representative in Montpelier, Vermont

Member Services Representative + Location: National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint + Job Family: UNN > Union 061 + Type: Full time + Date Posted:Jun 15, 2022 + Req #: PS68337 Description Member Service Representative (Must live within a commutable distance to Wixom) Job Description Job Title: Member Service Representative (Must live within a commutable distance to Wixom) Exemption Status: Non-Exempt Reports to: Manager, Member Services Job Code: ST918 Salary Grade: Union – Grade 4 General Summary: Answer subscriber and provider questions about benefits, eligibility, claims and certification. Ensure customer satisfaction and promote a positive corporate public image. Screen incoming subscriber and provider calls/inquiries and take data to initiate cases. Quote accurate benefit and policy information regarding inpatient and alternative levels of care. Handle complicated inquires and educate providers/subscribers in the certification process and reconcile inconsistencies and procedural difficulties, when necessary, Perform all data entry for case initiation and update and enter data into system for non-participating providers. Special projects and all other duties as assigned. Duties and Responsibilities 1. Perform responsibilities and tasks in ways that promote good will, build positive relationships, preserve human dignity, and contribute positively to the corporation service orientation. Service calls in a professional and courteous manner. Perform review of service requests for completeness of information. 2. Answer telephone calls identifying those needing case management services, those needing referral to routine outpatient services, and those needing authorization and/or verification. Answer questions from providers, members, insurance carriers and/or Beacon regional offices. Certify benefits per account specific guidelines. Provide list of in-network providers to callers. Explain benefits and benefit maximums that have been reached. Verifies benefits against contract requirements prior to case initiation. Refers complicated cases to Case Managers. Collect and transfer non-clinical data. Acquire structured clinical data. Perform activities that do not require evaluation or interpretation of clinical data. 3. Attend all staff meetings, team conferences and in-service as directed. Comply with all credentialing and other PSO requirements. Assist to train new unit personal and to set up new clinical case management units as directed. Assist in special projects as directed by the Department Manager/Supervisor. Assist clinical area managers to prepare for re-authorization of services by gathering necessary information and retrieving relevant subscriber files. Assist to maintain subscribers’ files. Assist Clinical Case Managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility, and researching provider information. 4. Record complaints, grievances and appeals. 5. Collects demographic data from providers/subscribers for case initiation. Completes data entry for authorizations. Perform data entry for case initiation and updates. Research and investigate claims inquiries. Document all inquiries. 6. Apply Beacon policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations, accuracy, productivity, and performance standards. Support Beacon in achieving Mission Statement. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment. Complete tasks accurately and within required timeframes. Qualifications - External: Requirements: + Bachelors’ degree in Social Work, Psychology or equivalent in a related health care field. + A minimum of one year of customer service experience or experience in the behavioral health care field. + Strong customer service orientation, and excellent written and verbal communication skills especially telephone service skills required. All applicants will be required to demonstrate their customer service skills by participating in a test phone call simulation. Preferred Qualifications: + Must demonstrate ability to quickly summarize telephone conversations and accurately input to a computer. Must demonstrate ability to maintain a professional demeanor during a crisis situation. Excellent time management and organizational skills needed. Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Be part of an Extraordinary Team Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contactability@icareerhelp.comfor assistance. EEO is the LawEqual Opportunity Employer / Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. + EEO Policy Statement + EEO is the Law Postero + EEO Poster Supplement-English Version + Pay Transparency + Privacy Notice for California Residents Elevance Health, Inc. is an E-verify Employer Need Assistance?Email us ( or call 1-877-204-7664