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Membership Services Advocate


Posted: 10/2/2019
Job Reference #: 5000531830506
Categories: Other/General

Job Description

Employment Type


Exempt or Non-Exempt


Job Summary

To provide Best Customer Experience, Most Affordable Care, and Best Quality Care, by resolving enrollment, eligibility and billing issues and inquiries from members and employer groups accurately and timely. Ensure that all government, association and department guidelines, objectives and performance standards are met. Perform quality assurance audits and provide recommendations to improve customer satisfaction.

Minimum Qualifications

  1. Associate's degree and one year work experience or equivalent combination of education and experience.
  2. Strong customer service skills.
  3. Strong organization skills.
  4. Strong decision-making and problem analysis skills.
  5. Demonstrated ability to work independently with minimal supervision.
  6. Demonstrated ability to multitask, managing time and priorities appropriately.
  7. Demonstrated ability to perform detail-oriented work.
  8. Excellent writing skills.
  9. Skilled in using Microsoft Office.

Duties and Responsibilities

  1. Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by:
    • Researching and collaborating with other units or departments to find a solution
    • Accurately updating member records
    • Contacting external partners who provide services to HMSA's members
    • Providing member or group education on enrollment, billing (bill presentment) and bill payment
    • Promoting electronic and bill payment options
  2. Support unit in performing enrollment and billing reconciliations activities for purpose of identifying discrepancies and initiating accurate and timely correction/resolution of internal as well as external processing systems. Support unit in daily enrollment functions to include processing of enrollments, disenrollments and maintenance for members. Perform quality assurance audits of customer inquiries and member updates within constrained timeframes. Based on patterns or risk assessment, recommend improvement opportunities to provide processing efficiency and increase customer satisfaction. These can include but are not limited to identifying processing or servicing issues that can be addressed by a system or a workflow solution.
  3. Training and Development.
  4. Perform other duties as assigned.