Member Services Representative - (CF11468)

Centene Corporation provides multi-line managed care programs and related services to individuals receiving benefits in Medicaid, including Supplemental Security Income (SSI) and the State Children's Health Insurance (SCHIP). Centene operates health plans in seven states. In addition, the Centene contracts with other healthcare organizations to provide specialty services including behavioral health, disease management, nurse triage and treatment compliance.

POSITION PURPOSE: Perform duties to receive and respond to member inquiries via telephone and written correspondence in a timely and professional manner for Bridgeway Health Solutions. Bridgeway provides services to low income older persons and people with disabilities through the ALTCS Program in Maricopa and Yuma/LaPaz counties.

POSITION QUALIFICATION REQUIREMENTS:
Knowledge/Experience: Thorough skills and knowledge of customer service and/or claims processing, and the operation of office equipment such as personal computer. Equivalent to high school education. Over 1 year up to and including 3 years of customer service experience, preferably in a healthcare or insurance environment. Over 3 months up to and including 12 months of data entry experience.

Skills/Competencies: Apply commonsense understanding to carry out instructions furnished in written, oral or diagram form. Deal with problems involving several concrete variables in or from standardized situations.
Perform the basic functions of arithmetic; add, subtract, multiply and divide all units of measure. Compute ratio, rate and percent. Draw and interpret bar graphs. Perform reading, writing and speaking at an intermediate level, demonstrating good oral and written communication skills, as well as attention to details. Ability to use computer systems for the management of member and claims information.

CRITICAL JOB ELEMENTS: Normal office work environment. Dexterity of hands and fingers and little physical effort. Normal mental effort, including timeliness of decision making, memory, and analytical thinking. Excellent verbal and non-verbal communications skills. Ability to hear and speak.

PRINCIPAL FUNCTIONS & ACCOUNTABILITIES:
Customer Service: Receive and respond to all telephone or written correspondence inquiries from members within established timeframes. Educate members regarding plan benefits via telephone, in writing, or make referral to outreach representative as appropriate. Maintain confidentiality per HIPAA guidelines.
Documentation: Document in the computer system all members' issues and resolution. Maintain and update reference materials as directed.

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