Member Service Support Specialist

Job not on LinkedIn

🕒 6 days ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

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NationsBenefits

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2013

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 Private Equity Round on 2022-04

Healthcare • Consulting • Logistics

NationsBenefits is a leading healthcare technology company that specializes in providing financial technology solutions and supplemental benefits management. The company offers a variety of services, including hearing care through NationsHearing, health and wellness products via NationsOTC, and meal delivery through NationsMarket. NationsBenefits also provides specialized services like emergency assistance, healthcare transportation, and personalized health guidance using artificial intelligence. Their proprietary platforms, including Benefits Pro™, facilitate member support, benefit configuration, and e-commerce transactions. NationsBenefits focuses on improving member outcomes, closing care gaps, and enhancing satisfaction through advanced analytics and custom programs.

📋 Description

• Answer inbound calls from members and providers regarding health plan benefits, claims, eligibility, and general inquiries • Research, locate, and provide accurate information while ensuring a positive customer experience • Resolve member service issues by identifying concerns, researching solutions, implementing appropriate resolutions, and escalating complex issues when necessary • Review and analyze claims based on diagnosis codes, procedures, provider information, medical policies, contracts, and established policies and procedures • Educate members and providers on benefits, coverage, and health plan processes • Identify members who may benefit from care management or managed care interventions and collaborate with clinical staff to facilitate appropriate services • Document all interactions accurately and thoroughly in accordance with company policies and regulatory requirements • Maintain compliance with HIPAA and applicable healthcare regulations • Meet productivity, quality, attendance, and customer satisfaction standards

🎯 Requirements

• High School Diploma or GED required • Strong computer and data entry skills • Excellent verbal and written communication skills • Strong problem-solving and critical-thinking abilities • Ability to multitask and navigate multiple systems simultaneously • Attention to detail and commitment to accuracy • Ability to work independently and as part of a team • Professional demeanor with a strong focus on customer satisfaction • Previous call center or customer service experience preferred • Working knowledge of Medicare and Medicaid programs preferred • Minimum of one (1) year of customer service or call center experience preferred • Healthcare, insurance, Medicare, or Medicaid experience preferred • Knowledge of health plan systems, products, policies, procedures, and departmental functions • Ability to maintain HIPAA and healthcare regulatory compliance

🏖️ Benefits

• Career advancement opportunities from within the organization • Fulfilling work environment • Opportunities across multiple locations in the US, South America, and India