Member Services Rep II
Company: Confluence Health
Posted on: May 3, 2021
The Accountable Care Department is responsible for the Confluence
Health (CH) Employee Plan and Health Alliance Northwest Medical
Plans, ensuring that each patient gets the right care, at the right
time, at the right location. The Member Services Representative II
will be responsible for providing customer service functions to
members, providers, and vendors associated with Health Alliance
Northwest Medical Plans which includes Medicare Advantage, CH
Employee Plan, Small Group and Individual Plans in both the CH and
Yakima Markets, in addition to Health Alliance Plans in
Position Reports To:
Director of Value Based Care
- Responsible to provide the highest quality customer service
both over the phone, and in person, on behalf of Health Alliance NW
Medical Plans which includes calls being recorded and audited to
mitigate misquotes and to meet performance measures.
- Patiently listen to, accurately understand, and quickly respond
to issues in an effort to help others as well as to help HANW
Medicare Advantage Plans meet Center for Medicaid/Medicare Services
(CMS) Star rating measures reflecting customer service.
- Completes exhaustive and thorough research of issues, to ensure
all concerns are addressed and resolved to customer satisfaction
and demonstrates the ability to know when to escalate issues to the
health plan grievance process.
- Is energetic and actively monitors work responsibilities such
as call productivity, to keep pace with work flow which include
call abandonment, service level, log adherence, and percentage of
time ready rates.
- Responsible to present Medicare Advantage plans with the intent
to sell the plan to prospective members who want to learn about
plan benefits so that they can make an informed decision. This
includes hitting CMS required compliance points.
- Possess the ability to communicate plan design, benefits, each
party's responsibility, and the overall healthcare billing process
by making the complex understandable.
- Demonstrates the ability to be an active listener, as well as a
contributor of ideas, in an effort to partner with others to
achieve high standards of team performance.
- Demonstrates the ability to be trained and become proficient on
both Confluence Health and Health Alliance computer/phone systems
as well as to adhere to two Organizations work flows and
- Provides timely and professional verbal and written
communication, keeping multiple parties informed of issue and
- Demonstrates ability to use sound and fair judgment, as well as
to be multi-faceted in both the health care and insurance knowledge
to answer questions and resolve issues for both Member's and their
Provider of care.
- Demonstrates the ability to work cooperatively with other's
both internally and outside of Confluence Health to achieve shared
objectives in the highest level of service .
- Demonstrates the ability to handle pressure and manage crisis
effectively in addition to being exposed to CMS secret shoppers
both in person and over the phone, while maintaining a positive and
- Responsible to learn multiple health plan benefits, complete
monthly competency quizzes, pass annual Medicare testing, and keep
up on CE required to keep Producer's license active.
- Demonstrates ability to balance responsibilities and work as a
team in sharing daily responsibilities.
- Other duties as assigned.
Demonstrate Standards of Behavior and
adhere to the Code of Conduct in all aspects of job performance at
- High School diploma or equivalent.
- 1 year experience providing customer service.
- 1 year experience in an office setting possessing intermediate
computer knowledge such as MS Office.
- To have/obtain Insurance Producers License.
- Demonstrated proficiency in letter writing skills and effective
- Insurance Producers License.
- Demonstrated Professionalism, Drive and Resourcefulness.
- Demonstrated ability to use sound judgment.
- Demonstrated ability to work as part of a team, maintaining a
positive demeanor during challenge.
- Understands and makes use of the decision-making authority that
has been granted.
O = Occasional, represents 1 to 25% or
up to 30 minutes in a 2 hour workday.
F = Frequent, represents 26 to 50% or up to 1 hour of a 2 hour
C = Continuous, represents 51% to 100% or up to 2 hours of a 2
Physical/Sensory Demands for This
• Walking – F
• Sitting/Standing - C
• Reaching: Shoulder Height - F
• Reaching: Above shoulder height - O
• Reaching: Below shoulder height - O
• Climbing - Not Specified
• Pulling/Pushing: 25 pounds or less - O
• Pulling/Pushing: 25 pounds to 50 pounds - O
• Pulling/Pushing: Over 50 pounds - O
• Lifting: 25 pounds or less - O
• Lifting: 25 pounds to 50 pounds - O
• Lifting: Over 50 pounds - O
• Carrying: 25 pounds or less - O
• Carrying: 25 pounds to 50 pounds - O
• Carrying: Over 50 pounds - O
• Crawling/Kneeling - O
• Bending/Stooping/Crouching - O
• Twisting/Turning - O
• Repetitive Movement - F
This job operates in a professional office environment. Typical
working hours are Monday through Friday from 8am – 5pm. Potential
overtime and cross sharing of a late shift (11am – 8pm) with the
team. Involves regular contact with staff and the public. This role
routinely uses standard office equipment. Could involve possible
day travel, and requires a combination of working independently and
also working closely with others.
Physical Exposures for This Position:
• Unprotected Heights – No
• Heat – Yes
• Cold – Yes
• Mechanical Hazards – No
• Hazardous Substances – No
• Blood Borne Pathogens Exposure Potential – No
• Lighting – Yes
• Noise – Yes
• Ionizing/Non-Ionizing Radiation – No
• Infectious Diseases – No
Keywords: Confluence Health, Everett , Member Services Rep II, Other , Wenatchee, Washington
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