Offer summary

Qualifications:

High School Diploma or equivalent certification is required., At least one year of customer service experience with direct customer contact is necessary., Preferred experience includes working in a physician health care office or high-volume call center., Knowledge of HMO, PPO, TPA, PHO, and Managed Care functions is a plus..

Key responsabilities:

Handle daily member telephone calls, directing them to appropriate services.

Educate members and assist with problem-solving related to their inquiries.

Create linkages to the Medical Management Department for service authorizations.

Assist providers with eligibility, benefits, and claims resolution issues.

Job description

We are looking for a Customer Service Representative, Medicare Advantage to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org .

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/ .

Position Summary:

This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services.Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.

This position supports our Medicare population. Healthcare or Medicare customer service experience is preferred.

This position is fully remote.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Qualifications:

Required:

High School Diploma or equivalent certification;
One (1) year experience in a customer service related role with direct contact with customers via telephone, email, chat and/or face-to-face.

Preferred:

One (1) year experience in a physician health care office environment or high-volume call center.
One (1) year experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions.

Additional Information