Member Services Representative

Scope of Position

Responsible for serving as a liaison between members, providers, third-party vendors, and the university. Assists with member complaints, documents and corrects claims questions and problems, assists with medical benefit questions and explains medical benefits, schedules all screenings and educational programs, and other queries. Assists providers and third-party vendors calling on providers behalf with authorization information, insurance eligibility and benefits, verification of coverage, including CPT and diagnosis codes, out-of-pocket, deductible accumulations and how benefits are processed.

Position Summary

Works in a team environment to provide member service and resolve all Tier 1 calls (routine calls regarding medical plans, processes and procedures); answers provider/member phone calls in a timely and accurate manner; produces mail/electronic correspondence; provides general information on benefits and services; documents inquiries in tracking systems to ensure quality service; inputs data for case management and correspondence databases; researches pending claims and refers them on with recommendations for processing; researches and resolves complaints; maintains working knowledge of The Ohio State University Health Plan Inc. service departments and triages member inquiries to appropriate experts within OSUHP; works on special projects and provides administrative support as assigned. Requires successful completion of a background check(s).

Minimum Qualifications

• One to three years of member service experience

• Knowledge of Microsoft Office required

• Knowledge of medical benefits and managed care policies

• Previous working experience with automated/computerized call center phone systems desired

Our Comprehensive Employee Benefits Include

• An array of retirement plan options, each with a generous employer contribution.

• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.

• Paid vacation and sick leave, including short and long-term disability and paid parental leave.

• Get the most out of the Public Service Loan Forgiveness program.

• And much more!