Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
The Member Services & Provider Inquiry Representative has the primary responsibility for answering incoming telephone inquiries, written correspondence and in person inquiries from Plan Members and Providers about all services; benefits plan coverage, enrollment status, claims, billing and referral procedures.
- Answers verbal and written inquiries from plan Members and Providers and administers ongoing education regarding the Plan benefits, policies, and procedures.
- Answers in-person inquiries from Plan members regarding the Plan benefits, policies and procedures
- Coordinates resolution of member and provider inquiries / complaints within the timeframes outlined in department policies and procedures.
- Maintains excellent documentation of member and provider inquiries, which provides detailed information of each inquiry, including the resolution of the inquiry.
- Assists Plan members with Primary Care Provider (PCP) changes
- Mails educational and support materials upon request
- Updates the member/patient database by entering, verifying, or correcting demographic data of persons requesting information, assistance or complaint resolution
- Gives updated Provider demographics / billing information to provider Contracting / Network Development
- Provides providers current claim status, payment information, and helps educate them about the Provider Portal.
- Delivers service in a courteous, friendly and professional manner, to both internal and external customers
- High school diploma or equivalent.
- 2+ years experience in the area of customer/member services; preferably in a healthcare setting.
Terms of employment may require the applicant/incumbent to qualify, obtain and maintain a Position Level of Trustworthiness from the U.S. Government Office of Personnel Management. Additionally, this position may require the applicant/incumbent to be a U.S. citizen.
- Excellent customer service skills
- Ability to work efficiently and independently.
- Analytical skills in research and problem resolution.
- Strong computer skills (keyboard proficient, quick data entry with a high level of accuracy).
- Able to work cooperatively with other departments.
- Multi-task oriented with the ability to prioritize.
- Detail oriented.
- Well organized with excellent follow up skills.
- Ability to handle crisis situations and easily adapt to change.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: email@example.com