Claims Member Services Representative

Job Overview
We are looking for a highly motivated individual with Member Service and Claims experience for a busy Medical Claims Department. The ideal candidate will be creative, observant and very attentive to detail. Excellent communication, computer and problem solving skills, and a willingness to dig in and work alongside other members of the department are critical. The role includes both claims processing and providing customer service over the phone.

The department processes a variety of claims, including medical, dental, short term disability and life claims. In addition to processing claims, each member of the team is expected to assist with member with phone calls for inquiries such as eligibility and benefits, claim status and benefit coverage questions.

We are looking for someone who is organized, responsive, takes initiative, works will independently, maintains a positive attitude and strives to maintain the company's culture.

Responsibilities

• Serve as the primary contact for members, addressing inquiries and providing information regarding services and benefits.
• Assist in the processing of medical documentation and ensure accuracy in member records.
• Organize and maintain files related to member services for easy access and retrieval.
• Collaborate with healthcare providers to facilitate seamless communication regarding member needs.

Qualifications

• Familiarity with ICD-9 coding, DRG classifications, HCPCS codes
• Strong organizational skills with the ability to manage multiple tasks efficiently.
• Excellent communication skills, both verbal and written, to interact effectively with members and healthcare professionals.
• A commitment to providing high-quality customer service in a fast-paced environment.

About NEBA

At NEBA, we are very proud of our commitment to creating community, supporting healthy lifestyles, offering educational opportunities and providing tools and resources that foster personal and professional development. We believe in promoting from within and creating career paths that pave the way for our employees to move all the way from entry level to high level leadership positions within our organization. We offer competitive wages and an excellent benefit package that includes unique features, such as professional coaching, as part of our employee enrichment program. We are invested in the success of our employees!

We do important work at NEBA, administering collectively bargained employee benefits for hard working men and women all over the country. The community we serve deserves excellence, and we have high expectations that every one of our employees consistently works towards delivering it.

NEBA employees have excellent work ethic, make continual contributions to go above and beyond to help others, have a positive attitude, display kindness towards others, respect their coworkers, and are willing to do what it takes to get results! Does this sound like you? If it does, please apply for this career opportunity.

NEBA is an Equal Opportunity Employer committed to hiring a diverse work team.

Job Type: Full Time

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Pembroke Pines, FL 33028

Education:

• High school or equivalent (Preferred)

Experience:

• Customer service: 1 year(Required)
• Claims Adjudication: 1 years (Preferred)

Work Location: In person

Job Type: Full-time

Pay: $16.00 - $16.50 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Application Question(s):

• What is your hourly rate requirement?

Education:

• High school or equivalent (Preferred)

Experience:

• Member Services : 1 year (Required)
• Medical claims : 1 year (Preferred)

Ability to Commute:

• Pembroke Pines, FL 33028 (Required)

Work Location: In person