Member Service Representative

Mercy Health Corporation
$19.40/Hr - $31.04 /Hr.
vision insurance, paid time off, retirement plan
United States, Wisconsin, Janesville
580 N Washington St (Show on map)
Apr 16, 2025
Overview Responds to all incoming correspondence and telephone inquiries directly related to the position in a professional manner consistent with the health system's mission. Attend seminars/training sessions. They may be required to work overtime during peak periods. Performs other duties as assigned. Responsibilities Essential Duties and Responsibilities Serve as a resource or Subject Matter Expert (SME) for other team members or internal members in the following areas: WI and Illinois Group EPO, HMO, PPO, POS lines of business WI and Illinois Individual Marketplace WI Medicaid WI Medicare Supplemental Insurance WI and Illinois Pharmacy Riders Handle escalated calls, resolving more complex member issues in a one-and-done manner Answer incoming phone calls from members and identify the type of assistance the member needs- Members or someone calling on behalf of members Providers Pharmacy Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Assist members in navigating Mercyhealth's websites and encourage and reassure them to become self-sufficient Assist members in choosing a primary care physician and scheduling their first appointment or when assistance getting an appointment is asked for by the member Own problem through to resolution on behalf of the member in real-time or through comprehensive and timely follow-up with the member Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues Provide education and status on previously submitted pre-authorizations or pre-determination requests Responsible for entering all approved authorizations into the pharmacy benefit management system. Also responsible for entering overrides to ensure members receive their prescriptions promptly. Assist in taking premium payments from members for our marketplace line of business. Meet the performance goals established for the position in the areas of first-call resolution, service level, occupancy rate, percentage of calls held, redirect, attendance, NCQA required audits, and any contractual requirements (ETF, Medicaid, etc.) Education and Experience High school education Benefits Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to: Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options. * Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs. * Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance. * Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth. * Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey. * Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.