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Member Services Rep II

Company: Confluence Health
Location: Wenatchee
Posted on: May 3, 2021

Job Description:

Position Summary:
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 Illinois.


Position Reports To: Director of Value Based Care

Essential Functions:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Possess the ability to communicate plan design, benefits, each party's responsibility, and the overall healthcare billing process by making the complex understandable.
  7. 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.
  8. 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 expectations.
  9. Provides timely and professional verbal and written communication, keeping multiple parties informed of issue and reconciliation status.
  10. 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.
  11. 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 .
  12. 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 confident demeanor.
  13. 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.
  14. Demonstrates ability to balance responsibilities and work as a team in sharing daily responsibilities.
  15. Other duties as assigned.

Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.


  • 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 two-way communication.



  • 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 workday.
C = Continuous, represents 51% to 100% or up to 2 hours of a 2 hour workday.


Physical/Sensory Demands for This Position:
• 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


Working Conditions:
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.


Job Classification:
FLSA: Non-Exempt
Hourly/Salary: Hourly

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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