Employment Type:

Part time

Shift:

Description:

Why MediGold?

               

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

About the job:

In accordance with the Mission and Guiding Behaviors; the Member Service Representative responds to all consumer inquiries received by phone, in person or in writing regarding product plan benefits, services, organizational determinations, reconsiderations, complaints and general inquiries in accordance with the rules and regulations of a Medicare Advantage plan and governing agencies.  Implements retention strategies to maintain current membership and improve the quality of care and service.

What you'll do:

• Exhibits each of the Mount Carmel Service Excellence Behavior Standards holding self and others accountable and role modeling excellence for all to see.  For example:  demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service.
• Meets population specific and all other competencies according to department requirements.
• Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence or adverse outcome to associates and patients.
• Relationship-based Care:  Creates a caring and healing environment that keeps the patient and family at the center of care throughout their experience at Mount Carmel following the principles of our interdisciplinary care delivery system.
• Complies with internal policies, Center for Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable Federal regulations.
• Develop a thorough understanding of the applicable rules and audit protocols that govern all aspects consumer service activities and demonstrated ability to pass audits of activities.
• Engages with consumers to effectively meet or exceed individual and team service performance goals in a manner that is compliant with all Federal, State and governing requirements.
• Receive, interpret and accurately respond to consumer inquiries, both verbally and in writing in ways that reflect a positive, compassionate and affirming manner while ensuring compliance with Federal regulations.
• To discern the needs of consumers with commitment to providing the highest level of service possible with measurable outcomes. 
• Utilize interpreting services and accurately provide answers to consumers via foreign language interpreters to assist limited English speaking consumers.
• Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.
• Consistently document and accurately code all inquiries within designated software to reflect the purpose of a consumer's inquiry and all actions taken to address and resolve their issue or need.
• Generate standard or customized letters and reports to accurately respond to inquiries as needed.
• To obtain and maintain a thorough knowledge of plan benefits, services, understanding of Federal rules and requirements and be able to communicate such knowledge to consumers effectively.

What we're looking for:

• Education:  Minimum of high school education with some college level studies preferred
• Experience: Customer Service along with knowledge of governmental agencies and regulations, especially Medicare and the Centers for Medicare and Medicaid Services (CMS) desired.
• Effective Communication Skills; consumer retention and strategic thinking.
• Demonstrated knowledge and effective organizing multi-tasks, in a high volume, fast-paced team environment.
• Knowledge of managed care benefit plans and products.
• PC proficient including word-processing, data entry, Microsoft office and various software.
• Medical terminology and medical claims processing a plus.

Position Highlights and Benefits:

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting