Member Service Representative Level 1

Description:

POSITION TYPE: Hourly, Non-Exempt

BARGAINING UNIT: Bargaining Unit

WORK ENVIRONMENT: Hybrid

SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with the delivery of health and pension benefits. Our 50+ employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance to one another to carry out our shared mission and common agreements for those we serve.

Position Summary:

The Member Service Representative, Level 1 will work in the Member Service Department to ensure that the quality of customer service provided to union members meet or exceeds the highest standard of the organization. Member Service Representatives will serve on the call center, providing administrative and professional customer service support to enroll members for health coverage, educate members about their benefits, and to confirm eligibility of coverage to members and medical providers. This work requires accuracy of benefit information provided, consistency in documentation of each call, and resolution of e any inquiries related to open enrollment, eligibility, status of medical claims and benefit plan administered by the SEIU Healthcare IL Benefit Funds. In-person customer service may also be required.

This position will work closely with all Member Service team members as well as other department staff throughout the organization. Providing excellent customer service and clear and accurate communication with all stakeholders is vital for this role.

The Member Service Representative, Level 1 will be responsible for the following:

Key Duties and Responsibilities:

• Educate members on eligibility requirements, covered/uncovered services, plan options and benefits, and best healthcare practices
• Provide members with status on their medical claims and advise members of their benefits and appeal rights
• Provide excellent quality service by following the call center’s phone scripts, policies, and procedures aiming to resolve matters on the first call
• Handle and resolve any open issues received via voicemail or postal mail
• Provide pre-service benefit, basic claim information, and patient responsibility to providers based on the participants’ selected plans
• Able to work in a high call volume environment with the ability to provide quality in-person assistance to plan participants who walk-in for support
• Enroll eligible members into the appropriate health plan based on the guidelines of the summary plan descriptions
• Create one-on-one (1:1) agendas with the Member Service Manager using the POP/ Agenda Model and takes notes based on the Standardized note taking process.
• Liaise non-English speaking plan participants who need support using a language line
• Professionally handle incoming calls from union members/plan participants, medical providers, vendors, and partners for all health plans
• Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for call center and member engagement trends, as well as identify potential process improvements
• Process enrollment with accurate data entry into the benefit administration system via phone enrollment or application form
• Back-up all duties of the Member Service Assistant as needed.
• Provide accurate benefit plan information to all members and medical providers; understand the differences in plan benefit options, including HMO, EPO, PPO, and other Medical Home plans and in-network facility locations
• Comprehensive working knowledge and resourceful use summary plan descriptions to differentiate between twenty-one (21) different health plans
• Meet required call center quality metrics
• Clear documentation, logging each inquiry, call type, referral code and supporting information into the benefit administration system

Privacy and Security Responsibilities:

This position requires employee to handle Personal Identifiable Information (PII) and Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer.

Requirements:

Education Requirements:

• Customer service certification preferred
• High school diploma or GED

Job Requirements:

• Meet or exceed 97% call handle ratio for quality and production standards
• Strong listener and attention to detail
• Ability to type 35 words per minute accurately
• Creative thinking and effective problem solving skills
• Must be well organized and detail oriented
• Ability to articulate basic enrollment, benefits and eligibility information and deliver high quality customer service
• Basic skills in Microsoft Office products (Word, Excel and Outlook); Intermediate skills preferred, including Power Point
• Exercise clear and concise judgment
• Strong accountability, with the ability to manage up laterally and work cooperatively
• Must have the ability to work independently and within a team environment
• Ability and willingness to assist in special projects and handle multiple tasks
• Excellent written and verbal communication skills
• Excellent interpersonal skills at all levels of business, including effectively communicating with peers, leads, managers, executives, and external partners
• Must demonstrate effective time-management, punctuality and ability to meet deadlines
• 2+ years of customer service experience in the healthcare, preferably in benefits administration; 2+ years of call center experience
• Intermediate user of desktop computers, laptop computers, printers, copiers, scanners, fax machines and other office equipment
• Excellent people skills and customer service orientation

Preferred Skills:

• Intermediate user of project management tools, Smartsheet preferred
• Internal and external awareness of social movements, labor movements, and political issues that impact the work and the organization
• Bilingual fluency in Spanish or other language relevant to the needs of the member population
• Experience working in a remote environment with laptop provided
• Intermediate user of virtual conference software, Microsoft Teams and Zoom preferred
• Knowledge of the Fund’s benefit administration system (basys)

Career Development & Continuing Education Opportunities: Yes

Benefits:

SEIU Healthcare IL Benefit Funds offers competitive compensation and comprehensive health benefits package which includes health coverage (medical, dental and vision) for employees and eligible dependents, including a no premium option for employee only; generous time off; and a defined benefit pension plan.

Diversity, Equity & Inclusion creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.