Member Solutions Representative

POSITION SUMMARY:

At Alegeus, we believe that when our clients succeed, we succeed.  For that reason, our Member Solutions Representatives receive the necessary training and support to provide consistent and reliable white-glove service and interactions with each and every customer interaction.  They are truly our front-line.

MAJOR RESPONSIBILITIES:

• Obtains caller information by answering telephone calls; authenticating account holders; verifying information
• Researches account and transaction records to resolve caller questions
• Demonstrates the ability to independently handle challenging customer interactions with tact, professionalism and minimal supervisory support
• Adheres to regulatory oversight policies and procedures with regard to caller interactions (providing correct and appropriate information, entering detailed notes on caller’s record regarding the nature of the call, maintaining and respecting caller privacy)
• Informs account holders about procedures related to use of services
• Maintains and improves quality results by adhering to standards and guidelines as well as recommending improved procedures
• Updates job knowledge by studying new product changes and system functionality; participating in educational opportunities
• Apply general processing procedures, and specific guidelines to correctly process claims.
• Review and interpret pending claims to determine the appropriateness of the claim status to take necessary actions within policy provisions.
• Examine information including authorizations, payments, denials, and resolve outstanding issues to meet client expectations.
• Explain rationale on claim adjustments, such as payments and denial decisions.
• Shift hours vary based on client accounts. Must be flexible to work any shift in the range of hours 8:00am-8:00pm Monday through Friday

EDUCATION/EXPERIENCE:

• Bachelor's degree or equivalent education and/or work experience preferred
• 2+years Customer Service Call Center experience 

SKILLS/KNOWLEDGE:

• Strong organizational, analytical skills, and strong attention to detail.
• Previous experience in customer service or claims processing in the Consumer Directed Health market a plus, with 1-2 years of broad and deep knowledge of HSA, FSA, HRA, DCA, and other Transit products.
• Excellent troubleshooting, decision making, and problem-solving skills.
• Solid interpersonal, verbal, and written communication skills.
• Ability to work well independently, and as a team member.
• Proven ability to multitask, adjust priorities, meet deadlines, and successfully operate in a fast-paced environment.
• Ability to follow through on and successfully execute tasks while adhering to specific quality standards. 

Alegeus is the market leader in consumer directed healthcare solutions, offering the industry’s most comprehensive platform for the administration of healthcare benefit accounts, the industry’s most widely-used benefit debit card, and powerful engagement solutions to help consumers maximize savings and optimize spending for their healthcare.  Over 300 clients – including health insurance plans, third party administrators and financial institutions – leverage Alegeus’ deep expertise and proven technology to administer benefit accounts for more than 29 million members and process more than $8.9 billion in consumer healthcare payments annually.  As the healthcare and benefit markets continue to evolve, Alegeus delivers solutions that enable clients to evolve their service offerings, operate their businesses more efficiently, and focus on their customers.