Member Services Representative
Role Overview
The role responds to complex customer inquiries in person and by telephone, and assesses, adjudicates and processes claims.
The incumbent needs extensive knowledge of company products and administrative procedures.
The position is open to people residing in Winnipeg and surrounding areas with valid work authorization.
Key Skills for This Role
Full Job Posting
About Manitoba Blue Cross
Manitoba Blue Cross is a Manitoba-based, not-for-profit health benefits provider.
The organization says it reinvests in its infrastructure, people and province to improve care and community impact.
Work environment and benefits
- The employer describes a hybrid work environment and flexible work schedules.
- Other listed offerings include a health benefit package, an onsite fitness center, casual dress, and personal and professional development.
Position summary
The role responds to complex customer inquiries in person and by telephone, and assesses, adjudicates and processes claims.
The incumbent needs extensive knowledge of company products and administrative procedures.
The position is open to people residing in Winnipeg and surrounding areas with valid work authorization.
Duties and responsibilities
- Handle inquiries about enrollment, billing, claims, payments, coverage and health benefit plans, seeking first-call resolution where possible.
- Explain coverage, benefits and claim requirements to members and providers; review processed claims and resolve issues.
- Complete inquiry tickets, forms and memos; adjudicate and process claims and pre-authorizations to performance standards.
- Assist with pended claims and client service-level agreements; maintain Coordination of Benefits information.
- Return incomplete claims and contact members or providers to obtain missing information.
- Keep current on provincial health plan benefits, particularly prescription drugs, travel health and vision care.
- Process lost-cheque indemnity bonds and route address-change and identification-card requests.
- Promote and sell travel products; assist members with online portal registration and navigation.
- Forward customer suggestions, complaints and potential group or individual health business leads to relevant teams.
- Assist with in-person inquiries, customer emails and travel-agent requests as required.
Requirements
- Extensive knowledge of the company’s products and administrative practices relating to company procedures.
- Must reside in Winnipeg or surrounding areas and have valid work authorization.
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